04 July 2016 07:00:12

Caught in the pain trap? You need to read this

A new review of thousands of studies on people with chronic pain (for three months or more) suggests almost three times as many people are suffering than previous statistics estimated.

If you're living in pain, it may be little consolation, but you are now officially allowed to say 'I told you so'. A new review of thousands of studies on people with chronic pain (for three months or more) suggests almost three times as many people are suffering than previous statistics estimated.

Researching pain is not as easy as you might think. For a start, your pain is yours, not anyone else's - which means studies rely on what people tell their researchers. You can't see pain. There is no simple scan or blood test that can put a number on pain, on how severe it is or how much it affects your life. What's more, pain is a feature of multiple very different medical conditions, which is why there have been moves to recognise pain as a condition in its own right. There are thousands of studies out there for subjects like neuropathic (nerve-related) pain, fibromyalgia, chronic widespread pain and so on. But they often use different definitions for 'severe', 'disabling' or 'widespread'. That means the researchers trawled through no fewer than 1,737 articles to find the 19 studies, looking at 140,000 adults in UK, which met their criteria.

This group of studies showed an average of 43% of people (ranging from 35-51%) suffer from chronic pain and one in seven with chronic widespread pain. That could mean 28 million people in the UK are affected. Perhaps not surprisingly, pain gets more common with age - from 14% in people aged 16-25 (still a worrying one in seven people) to 62% among the over-75s. Women are more likely than men to suffer from chronic pain and up to three in 10 people in the 18-40 age bracket may suffer daily.

Pain management and treatments

Some painful conditions can be treated - joint replacement surgery for osteoarthritis, for instance, can banish pain pretty much overnight. But surgery for low back pain is often more challenging, especially when it relates to more than one disc in the spine. People with inflammatory arthritis like rheumatoid arthritis or arthritis associated with psoriasis get multiple inflamed joints. And fibromyalgia involves tender, painful muscles and tendons all over your body.

As if the pain itself weren't bad enough, there's a vicious cycle. Living with chronic pain drags you down - it's with you every time you climb the stairs, lift a bag or even make a cup of tea. Many people don't even get respite when they're sitting or lying completely still. So it's hardly surprising it's closely linked with depression. But depression is thought to affect the way our brains process pain, so the depression itself can worsen pain, which makes us more depressed, which ...

Many of my patients are distressed when doctors and other healthcare professionals want to discuss their mood. They describe feeling belittled or disbelieved, as if the doctor thinks they're making their symptoms up or believe they should be able to 'snap out of it'. In fact, nothing could be further from the truth. Imaging studies show clearly that depression can have a profound impact on the way our brains process the messages it receives, and that having depression can amplify pain. The pain itself is only too real, but treating the underlying depression can affect the way your body perceives it.

That's why new national guidelines, such as the draft guideline on low back pain from the National Institute for Health and Care Excellence (NICE) put increasing emphasis on treating the whole patient, rather than just the affected square foot. In future, pain programmes are likely to see more programmes focussed on combining physical treatment with a cognitive-behavioural approach to addressing the impact of your pain on your emotional wellbeing.

Physical treatment - both medication and drug-free - will always have a part to play. So will strategies to help you adapt your life and live within your limitations without compromising the things that really matter. But for some of my patients, just knowing they're believed will be a good start.

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.