Chronic pain is poorly managed
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《英国医生杂志》
A fifth of adults in Europe have moderate to severe chronic pain, and in many cases their symptoms are inadequately managed, says a recent study.
Only one in 50 cases are managed by a pain specialist, and a third of patients are not currently being treated, says the study in the European Journal of Pain, published online on 10 August (www.sciencedirect.com, doi: 10.1016/j.ejpain.2005.06.009).
"We have documented that chronic pain is a major health care problem in Europe," wrote the authors, from the University of Oslo, Rikshospitalet University Hospital, Oslo, University Hospitals of Leicester NHS Trust, and Mundipharma International, Cambridge. "This needs to be taken more seriously by health care providers and those responsible for health care policies and allocations of resources."
The study was based on a computer assisted telephone survey that was designed to explore the prevalence, severity, treatment, and effect of chronic pain in 15 European countries and Israel. Almost 50 000 people took part, and screening interviews identified 4839 people with chronic pain for further, in-depth interviews.
The results show that 19% (9500) of the adults surveyed had moderate to severe chronic pain, seriously affecting their daily activities and their social and working lives. The prevalence of such pain varied from 12% in Spain and 13% in the United Kingdom and Ireland to 26% in Italy, 27% in Poland, and 30% in Norway. Arthritis was the most common reason given for pain. The back was the most common location for pain.
The interviews with the 4839 respondents with chronic pain showed that 66% reported moderate pain, 34% reported severe pain, 46% reported constant pain, and 54% reported intermittent pain. Fifty nine per cent had had pain for 2 to 15 years, 21% had been given a diagnosis of depression because of their pain, 61% were less able or unable to work outside the home, 19% had lost their job, and 13% had changed jobs because of their pain.
Forty per cent of those with long lasting or recurring pain (a different category from chronic pain) reported that their pain was not managed well. The percentage of people whose pain wasn't managed well varied markedly among the countries: from 27% to 29% in Finland, the UK, Ireland, and Germany, 40% to 45% in Israel, Italy, Norway, and Sweden, and 54% to 61% in Switzerland, the Netherlands, Belgium, and Denmark.
Although 23% of these respondents had at some time been to a pain specialist, only 2% were managed by such a specialist. "This suggests that specialist pain services are unavailable to a majority of chronic pain sufferers who could have benefited from specialised care," the authors wrote.
The results also show that 28% of respondents with pain thought that their doctor did not know how to control their pain. More than 60% of people currently using prescription drugs for their pain said the drugs were sometimes inadequate.
A third of the people with chronic pain were currently not being treated. Of the two thirds who used alternative treatments, 30% used massage, 21% used physical therapy, and 13% used acupuncture.
Two thirds of those with chronic pain were taking prescription drugs, including nonsteroidal anti-inflammatory drugs (44%), weak opioids (23%), paracetamol (18%), cyclooxygenase-2 inhibitors (6%) and strong opioids (5%).
Mundipharma International, who funded the survey, is seeking licences for various drugs, including analgesics.(Roger Dobson)
Only one in 50 cases are managed by a pain specialist, and a third of patients are not currently being treated, says the study in the European Journal of Pain, published online on 10 August (www.sciencedirect.com, doi: 10.1016/j.ejpain.2005.06.009).
"We have documented that chronic pain is a major health care problem in Europe," wrote the authors, from the University of Oslo, Rikshospitalet University Hospital, Oslo, University Hospitals of Leicester NHS Trust, and Mundipharma International, Cambridge. "This needs to be taken more seriously by health care providers and those responsible for health care policies and allocations of resources."
The study was based on a computer assisted telephone survey that was designed to explore the prevalence, severity, treatment, and effect of chronic pain in 15 European countries and Israel. Almost 50 000 people took part, and screening interviews identified 4839 people with chronic pain for further, in-depth interviews.
The results show that 19% (9500) of the adults surveyed had moderate to severe chronic pain, seriously affecting their daily activities and their social and working lives. The prevalence of such pain varied from 12% in Spain and 13% in the United Kingdom and Ireland to 26% in Italy, 27% in Poland, and 30% in Norway. Arthritis was the most common reason given for pain. The back was the most common location for pain.
The interviews with the 4839 respondents with chronic pain showed that 66% reported moderate pain, 34% reported severe pain, 46% reported constant pain, and 54% reported intermittent pain. Fifty nine per cent had had pain for 2 to 15 years, 21% had been given a diagnosis of depression because of their pain, 61% were less able or unable to work outside the home, 19% had lost their job, and 13% had changed jobs because of their pain.
Forty per cent of those with long lasting or recurring pain (a different category from chronic pain) reported that their pain was not managed well. The percentage of people whose pain wasn't managed well varied markedly among the countries: from 27% to 29% in Finland, the UK, Ireland, and Germany, 40% to 45% in Israel, Italy, Norway, and Sweden, and 54% to 61% in Switzerland, the Netherlands, Belgium, and Denmark.
Although 23% of these respondents had at some time been to a pain specialist, only 2% were managed by such a specialist. "This suggests that specialist pain services are unavailable to a majority of chronic pain sufferers who could have benefited from specialised care," the authors wrote.
The results also show that 28% of respondents with pain thought that their doctor did not know how to control their pain. More than 60% of people currently using prescription drugs for their pain said the drugs were sometimes inadequate.
A third of the people with chronic pain were currently not being treated. Of the two thirds who used alternative treatments, 30% used massage, 21% used physical therapy, and 13% used acupuncture.
Two thirds of those with chronic pain were taking prescription drugs, including nonsteroidal anti-inflammatory drugs (44%), weak opioids (23%), paracetamol (18%), cyclooxygenase-2 inhibitors (6%) and strong opioids (5%).
Mundipharma International, who funded the survey, is seeking licences for various drugs, including analgesics.(Roger Dobson)