We constantly hear about cancer, diabetes and heart disease. I think it's good. Not that you love hearing about diseases, of course, but if something is talked about, it means that you are not sweeping it under the rug pretending that it does not exist. Talking about it probably also means more prevention, more research.
Obviously, the perception that results is that cancer, diabetes and heart disease are the great evils of our time. What if I told you that things are not exactly like that? It is estimated that around 1,5 billion people worldwide suffer from chronic pain. That's a huge number, more than those with cancer, diabetes and heart disease combined. This data is obviously a projection made in the light of some surveys conducted in Europe, the USA and Australia and Asia. It affects at least one adult in five, leaving out children and adolescents. Studies conducted at European level confirm that persistent pain has a significant impact on daily life, sociality and the quality of life of those affected.
Between half and 2/3 of those who live with persistent pain, their ability to rest normally, move, participate in social activities, drive a car, have a normal sex life diminished. Not to mention that one in four people say that relationships with friends or family have thinned or interrupted. One in three is less able, or completely unable, to maintain an independent lifestyle. One in five is depressed due to pain. 17% suffer so much, at times, that they would like to die. Some actually kill themselves, but the study doesn't say how many. 39% of respondents feel that their pain is not being managed properly and that doctors do not consider pain a problem. Chronic pain, not wanting to consider the psychosocial aspect, because for now we assume that we are heartless and we don't care about the suffering of others, has a tremendous economic impact.
Let us reason as if we were Ebeneezer Scrooge: lumbar pain alone is one of the most impactful economic burdens in developed countries. In fact, it implies costs for treatment, for welfare, but also for the absence from work and the decline in performance of those who have to take on the tasks of absent colleagues, loss of earnings for companies and for the patient, decrease in earnings and, therefore, the possibility of spending for those who eventually find themselves in the position of having to support the relative forced inactivity due to chronic pain. Research also shows that people with persistent pain are more at risk of losing their jobs and often unable to work outside the home. In short: we are talking about an apocalyptic problem, with tremendous social and economic implications.
So I think the legitimate question, without using bad words, is: "Why is the global pathological burden of chronic pain underestimated?" I've been looking for some answers. The answers that are there, when they are found, make you shiver. In this regard, a simple but rather interesting document came into my hands. A "Fact Sheet", entitled "Unrelieved Pain is a Major Global Healthcare Problem". Persistent pain is not diagnosed and is not treated because it is considered "psychosomatic", fruit of depression (I have already become a pressure cooker) that often afflicts those who suffer from chronic pain, therefore lacking a real organic cause. It is not diagnosed because treatments are considered futile. It is not diagnosed because pain is inevitable. It is not diagnosed because patients are old and have little to live, or are they too small and some still believe that children feel no pain, or that third degree burns are painless. Primarily, there is still an unacceptable ignorance of the subject. And I'm not saying that. The World Health Organization says so. Including the reasons why chronic pain is underestimated, which are fundamentally driven by a variety of goat biases (forgive me, I've been kind so far), What are the obstacles to the evaluation and treatment of chronic pain? I have a suspicion, but let's see what the "Fact Sheet" I have on hand tells us.
The first culprit is, ladies and gentlemen, ignorance above. Lack of knowledge or awareness. This problem does not only concern the poor patient or his family, who perhaps are florists and would have every right not to know a damn persistent pain, but also the health professionals, therefore those who should treat him, the poor patient and who , I suppose, I add, they should at least know more about him. Furthermore, we consider that in Europe, one in four patients with moderate or severe pain reports that the treating doctor has never asked questions about the pain, did not think he had pain problems and, in any case, even if he asked for information, we he paused briefly and was unable to provide a solution. That good news. Although the availability of opioid analgesics to relieve cancer pain has increased even in developing countries, thanks to the efforts of the World Health Organization, cancer pain is not the only severe persistent pain that exists and opioids do not exist. they are the only drugs needed to treat it, so most people with persistent pain remain without adequate drugs worldwide.
And what is done to change this state of affairs? We educate ourselves. You study, you learn. Such as? By changing university programs, for example. Reading scientific journals. Going to training courses. By ceasing to consider themselves intellectually and morally superior to their patients, because a degree in a medical health profession does not ennoble man.
It's a big problem, I'd say. And I don't think the World Health Organization and the International Association for the Study of Pain have been very successful.
The Fact Sheet I am reading is from 2004. It was produced on the occasion of the First Global Day Against Pain by the International Association for the Study of Pain - IASP and the European Federation of Chapters IASP - EFIC, with the co-sponsorship of the Organization World Health. Old news? In terms of time for sure. If we rely on the results, frankly, the contents seem very valid to me.
Something is moving, it's true. But there is still a tremendous disconnect between clinical practice and scientific research. And it's not admissible. We need to keep talking about pain. There is nothing ignoble or complaining about doing this. It would be like not talking about cancer, because it is not dignified or makes us sad or it is not "manly". To me it would seem just incredibly stupid.
Unrelieved Pain is a Major Global Healthcare Problem, Fact Sheet, IASP - EFIC