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FACT SHEET ON CHRONIC NONMALIGNANT PAIN (CNP)
by Marcia E. Bedard, Ph.D
* CNP, pain that lasts six months or more and does not respond well to conventional medical treatment, affects more people than any other type of pain. Thirty-four million Americans suffer from chronic pain, and most are significantly disabled by it, sometimes permanently. (1, 2, 15)
* The economic impact of CNP is staggering. Back pain, migraines, and arthritis alone account for medical costs of $40 billion annually, and pain is the cause of 25% of all sick days taken yearly. The annual total cost of pain from all causes is estimated to be more than $100 billion. (2, 4, 15)
* Despite the magnitude of suffering, CNP remains grossly under treated in most patients. The reasons for this are: the low priority of pain relief in our health care system; lack of knowledge among both health professionals and consumers about pain management; exaggerated fears of opioid side effects and addiction; and health professionals' fear of medical board and DEA scrutiny, even when controlled substances are used appropriately for pain relief. (2, 13, 14, 15)
* Contrary to common fears, numerous studies have shown addiction is extremely rare in pain patients taking opioid drugs, even in patients with histories of drug abuse and/or addiction. CNP patients will develop a physical dependence on opioid drugs, but this is not the same thing as addiction, which is an aberrant psychological state. (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14)
* Unrelieved pain has many negative health consequences including, but not limited to: increased stress, metabolic rate, blood clotting and water retention; delayed healing; hormonal imbalances; impaired immune system and gastrointestinal functioning; decreased mobility; interference with appetite and sleep, and needless suffering. CNP also causes many psychological problems, such as feelings of powerlessness, hopelessness, low self-esteem, and depression. (12, 15, 16, 18, 19)
* Undertreatment of CNP often results in suicide. In a recent survey, 50% of CNP patients had inadequate pain relief and had considered suicide to escape the unrelenting agony of their pain. Unrelieved pain also leads to requests for physician-assisted suicide, another indicator of pain's harsh impact on the quality of life of many patients and their families. (7, 8, 13, 14, 15, 16,)
* Discrimination against CNP patients is pervasive in the American health care system. Women, racial/ethnic minorities, children, the elderly, worker's compensation patients, and previously disabled patients (e.g., those with cerebral palsy, or who are deaf, blind, amputees, survivors of childhood polio, etc.) are at great risk for under treatment of their pain, even though patients belonging to one or more of these groups are the vast majority of all CNP patients. (2, 13, 17)
* CNP patients with severe, unrelenting pain from permanent structural damage to the neurologic or musculo-skeletal systems are often subjected to expensive and unnecessary surgeries and other painful invasive procedures. Arachnoiditis and reflex sympathetic dystrophy are the most common causes of severe CNP. Other common causes include: post-trauma, adhesions, systemic lupus, headaches, degenerative arthritis, fibromyalgia, and neuropathies. (8, 15, 18, 19)
(1) American Chronic Pain Association. "Coping with Chronic Pain." 1995.
(2) Brownlee, Shannon, and Joannie M. Schrof. "The Quality of Mercy." U.S. News and World Report, March 17, 1997: 55-57, 60-62, 65, 67.
(3) Pasero, Christine L., R.N., B.S.N., and Margo McCaffery, R.N., M.S., F.A.A.N. "Pain Control." American Journal of Nursing. Vol. 97, No. 6., June, 1997: 20-21.
(4) American Academy of Pain Medicine and American Pain Society. "The Use of Opioids for the Treatment of Chronic Pain." Clinical Journal of Pain, Vol. 13, March, 1997: 6-8.
(5) Medina J.L., M.D., and S. Diamond, M.D. "Drug Dependency in Patients with Chronic Headache." Headache, 1977, Vol. 17: 12-14.
(6) Porter J., M.D. and H. Jick, M.D. "Addiction Rare in Patients Treated with Narcotics." New England Journal of Medicine 1980, Vol. 302: 123.
(7) Hitchcock, Laura S., Ph.D., et al. "The Experience of Chronic Nonmalignant Pain." Journal of Pain and Symptom Management, Vol. 9, No. 5, July 1994: 312-318.
(8) Tennant, Forest, M.D., Dr. P.H., and Harvey Rose, M.D. "Guidelines for Opioid Treatment of Stage III Intractable Pain." California Task Force on Opiod Treatment of Stage III Intractable Pain. January 1, 1997. Research Center for Dependency Disorders and Chronic Pain Community Health Projects Medical Group, West Covina, CA
(9) Zenz, Michael M.D., et al. "Long-Term Oral Opioid Therapy in Patients With Chronic Nonmalignant Pain," Journal of Pain and Symptom Management, Vol. 7, No. 2, February 1992: 69-77.
(10) Friedman, David P., Ph.D. "Perspectives on the Medical Use of Drugs of Abuse." Journal of Pain and Symptom Management, Vol. 5, No. 1 (Suppl.) February 1990: S2-S5.
(11) Portenoy, Russell K., M.D. "Chronic Opioid Therapy in Nonmalignant Pain." Journal of Pain and Symptom Management, Vol. 5, No. 1 (Suppl) February 1990: S46-S62.
(12) Dellasega and Keiser. "Pharmacologic Approaches to Chronic Pain in the Adult." Nurse Practitioner. Vol. 22, No. 5, May 1997: 20-25.
(13) Medical Board of California. "Prescribing for Pain Management." May 6, 1996.
(14) California Board of Pharmacy. "Health Notes: Pain Management." 1996.
(15) Canine, Craig. "Pain, Profit, and Sweet Relief." Worth. March, 1997: 79-82, 151-157.
(16) Liebeskind, J.C. "Pain Can Kill." Pain, Vol. 44, No. 1, January 1991: 3-4.
(17) Morse, T.B. "America's War on the Disabled." Albuquerque, NM: 60's Press.
(18) National Institute of Arthritis and Musculoskeletal and Skin Diseases. "Scientific Workshop Summary: The Neuroscience and Endocrinology of Fibromyalgia." July 1996. Bethesda, MD.
(19) Davis, Nadyne, et al. (eds.). "Third Annual Fibromyalgia Research Conference." February 1994. Inland Northwest Fibromyalgia Association. Spokane, WA 99206
Fact sheet prepared on July 15, 1997, by Marcia E. Bedard, Ph.D., Professor of Women's Studies, California State University, Fresno, CA 93740-0078. It may be reproduced in print or electronic form by any individual or group for educational purposes. Comments may be sent to the author at the above address or by e-mail to: email@example.com. Special thanks to Barbara Acello, Ann LeBlanc, and Rachael McKenna for research assistance, as well as CNP patients on the Internet who sent me so many excellent suggestions for additions. -MB-
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