Everybody Hurts: Check the Time Stamp on Those Chronic Pain Estimates
I sometimes think of the wheelbarrow from that famous William Carlos Williams poem when I see citations in journal articles attempting to justify that anywhere from 75 million to 150 million Americans are in chronic pain and yet very few are being treated for that pain.
So much depends upon a superscript numeral.
Glazed with importance.
Beside the statistics.
I explained Monday why some of these citations should be double-checked. Let’s examine one recent example.
The journal Pain Medicine published an article in September 2011 that began by defining the problem of chronic pain as a massive public health threat:
The phenomenon of chronic pain presents profound challenges to medical professionals and our system of medical care, as a whole. While more people suffer from chronic or persistent pain issues than heart disease, diabetes, and cancer combined, many living with pain suffer needlessly even though in many situations medical knowledge and treatments exist to manage such pain. Research suggests that pain affects 75-150 million Americans of whom only 3 million seek care from a pain specialist.
Note, first how vague the language is. It says, “Research suggests that pain affects 75-150 million Americans…” Taken in isolation, that sentence could be true. Haven’t we all been affected by pain? But remember that these statistics are being used to define the “phenomenon of chronic pain,” not just any pain at any time. So, are 150 million Americans – about half of all Americans – really in chronic pain?
I referred to this article before in a different context. Here I am going to attempt to find out where those claims are based.
All three of the numbers in that section are tagged with the same citation. The citation is not another scientific research paper in a peer-reviewed journal. It’s an essay by Dennis C. Turk in the American Pain Society newsletter.
Turk, a professor of anesthesiology and pain medicine at the University of Washington, was the society’s president when the article was written. He did not conduct original research to define the prevalence of chronic pain in the U.S., a logical assumption a reader might make about a paper being cited next to a set of statistics. He was simply citing other studies to make the points that some people appear to have developed coping mechanisms for handling pain without treatment and that people with pain who do undergo treatment are often seen as patients first rather than people. Excellent points. He wrote:
Because research has not provided us with all the answers we need to treat chronic pain patients effectively, it is worthwhile to ask targeted questions. What differentiates pain patients from the persons with pain? What factors contribute to pain patients’ ability to live effectively despite pain? What can we learn from studying those who have been able to transcend their experiences to help in the design of interventions? How do provider-patient interactions affect how patients live with pain?
By citing Turk’s 2005 piece, the Pain Medicine article makes it appear as if the statistics about people living with pain and being treated for pain are somewhat recent.
They are not.
Turk cited three papers for his estimates of how many people suffer from chronic pain and how many are being treated. The original 75 million to 150 million numbers come from two papers, one written in 1999 and another in 2003. The 3 million figure is even older, from 1995.
Much has changed since 1995, and even since 2003, not only in the awareness of pain as an important public health problem, but also with the tools used to treat pain.
To understand how each of these studies has been used to underscore the idea that there is a large unmet need among pain patients, I will start with the 1999 study in my next post.
Next: How 2,000 Scots Become 150 Million Americans in Pain
Image by Esther Simpson via Flickr