With so many people suffering, is a new era of pain management on the horizon?
By Julie Engebretson
The Centers for Disease Control and Prevention (CDC) has released its 30th annual report on the health status of the nation, Health, United States, 2006. The document, prepared by the Secretary of the Department of Health and Human Services for the President and Congress, frames a general picture of health and trends in health care utilization, resources and expenditures.
While the overall health of the nation seems to be improving or holding steady in many areas, results from the National Health Interview survey highlight the need for appropriate management of one particular condition: pain. Pain was such a prevalent complaint among those interviewed, researchers devoted a special section of the 2006 report solely to this condition. Titled "Special Feature: Pain," this section of the report focuses on pain as it affects various anatomical locations, including the low back, head, neck, face and joints.
As noted, the health of the nation continues to improve in several respects. This kind of improvement is attributable in part to the significant resources devoted to public health programs, research, health care and health education. All in all, life expectancy in this country is continuing a steady, upward trend. But as Americans are living longer, the question remains, "Are they living well?" Between 1999 and 2002, more than 25 percent of Americans over the age of 20 reported suffering pain - of any kind - that persisted for longer than 24 hours. Nearly 60 percent of adults older than 65 who reported pain indicated their pain lasted for an entire year or longer.
Adults 18 years and older were instructed to report whether they had experienced any of four types of pain during the three months prior to interview: low back pain, migraine/severe headache, neck pain, and facial ache in the jaw or joint in front of the ear. Respondents were asked to report only pain in the above-listed regions that lasted an entire day or more, excluding minor aches and pains. Low back pain was the most commonly reported of the four types of pain, the most common cause of job-related disability, and a leading contributor to missed work and reduced productivity. Though the percentage of adults reporting low back pain has remained stable in recent years, women of all ages, race and ethnicity groups, and income levels reported experiencing low back pain more frequently than men.
The second most frequently reported chronic pain type was severe headache and/or migraine. "In 2004, 15% of adults reported migraine/severe headache and 15% also reported neck pain. Adults 18 to 44 years of age reported migraine/severe headache pain almost three times as frequently as adults 65 years and older." The survey also revealed that severe headache pain was particularly prevalent among women still in their reproductive years.
Overall, the prevalence of severe joint pain increased with age. The knee was the site of joint pain most commonly reported, followed by the shoulder, fingers and hips. According to the report, "almost one-third of adults age 18 years and over and one-half of adults age 65 years and over reported joint pain, aching, or stiffness (excluding the back or neck) during the 30 days prior to interview." Results varied also by race and income. On a related note, the number of hospitalizations required to replace painful hips and knees has substantially increased since 1992 and 1993.
The prevalence of pain among U.S. adults also was measured by the use of prescription narcotics. The numbers are quite shocking. According to the report, "Between 1988-1994 and 1999-2002, the age-adjusted percentage of women reporting narcotic drug use in the month prior to interview increased by almost one-half, from 3.6% to 5.3%. During this period, use of narcotic drugs rose by almost 75% among women 45-65 years of age, to 5.7%; and by more than 50% among women 65 years and over, to 6.8%."
The impact of pain, particularly chronic pain, is far-reaching. It can affect everything from one's day-to-day activities and quality of life to the level of employee productivity at America's most powerful corporations. Conventional treatment of chronic pain is time-consuming and often very expensive, particularly over the course of several years. In fact, pain is such a prominent health care issue that the 106th U.S. Congress recently passed Title VI, Sec. 1603, of H.R. 3244, declaring the period between Jan. 1, 2001 and Dec. 31, 2010 the "Decade of Pain Control and Research."
As Americans are living longer, frustration with conventional approaches to pain management is evident. In fact, the CDC report speculates that pain among older adults often goes unreported due to many simply giving up, "and skepticism about the beneficial effects of potential treatments." With so many Americans in pain and dissatisfied with conventional treatment options, acupuncture and other alternative health professions may have a real opportunity to take the lead in a new era of pain management.
For a copy of Health, United States, 2006, including the section, "Special Feature: Pain," please visit www.cdc.gov/nchs/hus.htm.