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The Pain Never Goes Away

The Pain Never Goes Away

An estimated 55.7% of American adults (about 126 million persons) reported having some level of pain within the 3 months before they responded to an NIH survey. Substantially fewer (11.2%, or 25.5 million adults) had experienced chronic pain (pain every day for the past 3 months), felt a lot of pain (10.3% or 23.4 million adults), or were coded to the most severe Washington Group on Disability Statistics pain category (category 4: 6.3%, or 14.4 million adults).

The study provides evidence on the concurrent validity of the Washington Group pain categories in the general population—the pain categories clearly discriminate between different levels of health status, disability, and health care use. There was a strong relationship between pain categories and both health status and disability variables, but about 50% of responders who had category 4 pain still reported their overall health status as good or better.

In 2012, nearly 40 million adults (17.6% of all adults) were classified as falling within the 2 most severe Washington Group pain categories (3 and 4). They were more likely to have worse health status, to use more health care, and to experience more disability than those who had less severe pain.

Associations were seen between pain severity and selected demographic variables, including race, ethnicity, preferred language, sex, and age. The study was published in the journal Pain.

Design for dialogue on pain

“Design for Dialogue,” a program created to reduce challenges to open dialogue between doctors and patients about responsible pain management, has been launched by Teva Pharmaceutical Industries Ltd.

To start the PAINWeek National Conference (September 8-12, 2015, Las Vegas, NV) during Pain Awareness Month, Teva is asking persons who live with pain and health care professionals who treat pain to visit the Web site and offer ideas on the ideal exam room experience that would help foster conversations about the impact of pain, the risk of prescription drug abuse, and the role of abuse deterrence technology.

The program is featured on

Health care professionals and persons affected by pain recognized their personal responsibility in helping address prescription drug abuse, but acknowledged that conversations about the issue can be uncomfortable, in a survey conducted by Teva in collaboration with the American Academy of Pain Management and the U.S. Pain Foundation.

Design for Dialogue invites the pain community to reimagine the exam room experience and implement simple changes to the physical healthcare environment that can help address this discomfort.

Feedback from the pain community will be collected until December 31, 2015, and the ideal exam room experience will be revealed in early 2016.

More injections, continued poor response 

Use of epidural corticosteroid injections is increasing, and injections for radiculopathy were associated with immediate reductions in pain and function in a recent Annals of Internal Medicine study. But the benefits were small and not sustained and there was no effect on long-term surgery risk. Limited evidence suggested no effectiveness for spinal stenosis.

Chou and colleagues reviewed evidence on the benefits and harms of epidural corticosteroid injections in adults with radicular low back pain or spinal stenosis of any duration. Their data sources were Ovid MEDLINE (through May 2015), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, prior systematic reviews, and reference lists. The selected studies were randomized trials of epidural corticosteroid injections versus placebo interventions or comparisons of epidural injection techniques, corticosteroids, or doses.

For radiculopathy, epidural corticosteroids were associated with greater immediate-term reduction in pain, function, and short-term surgery risk. Effects were below predefined minimum clinically important difference thresholds, and there were no longer-term benefits. Limited evidence showed no clear effects of technical factors, patient characteristics, or comparator interventions on estimates.

There were no clear effects of epidural corticosteroid injections for spinal stenosis. Serious harms were rare, but harms reporting was suboptimal.

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