The Price Tag of Chronic Pain

Question: An 80-year-old with arthritis, a 50-year-old with a bad back, and a 20-year-old with migraines -- what do these people have in common?

Answer? Chronic pain. Pain was once viewed only as a symptom, the consequence of another condition. It was often ignored as doctors focused on treating its underlying medical cause.

But for almost everyone, pain is what matters. "It's pain that brings people into the doctor's office," says Penney Cowan, executive director of the American Chronic Pain Association. "It's pain that they want treated."

Pain has emerged as a devastating public health problem. According to the American Chronic Pain Association, pain is the No. 1 cause of adult disability in the U.S. At least one out of six people live with chronic pain.

Putting a Dollar Sign on Debilitating Pain

Yet estimates for the economic impact of pain vary. A 2003 study published in The Journal of the American Medical Association put the cost at $61.2 billion per year. But that's only the money drained from U.S. businesses because of productivity lost from employees in pain. It only included arthritis, back pain, headache, and other musculoskeletal pain; other kinds of chronic pain were excluded.

And while looking at pain's bottom line is important, no price can be put on the enormous suffering it causes.

"The costs are incalculable," says Christopher L. Edwards, PhD, assistant professor of psychiatry at Duke University School of Medicine. "How do you estimate the value of lost self-worth? How do you estimate the loss of family, friends, and a sense of accomplishment?"

What is causing all of this pain -- and cost? For the most part, it's the usual suspects:

• Back pain
• Neck pain
• Headaches
• Surgery
• Diabetes
• Cancer
• Joint pain
• Other conditions

And studies show the incidence of pain seems about the same among age groups. What changes is the type of pain.

For example, people in their 20s and 30s are more likely to suffer from debilitating headaches. The incidence of back pain peaks in middle age. The elderly often face arthritis and other painful conditions, like shingles. What unites these groups is the pain itself -- and the hidden costs that can change lives.

A Hidden Cost of Chronic Pain: Worsening Health

That's because pain can start a vicious cycle that has a direct impact on your health.

Perhaps your knee starts hurting when you walk. The natural response for many is to walk less. But "if you stop walking, the muscles, tendons and nerves in your legs atrophy and deteriorate," says Edwards. "If you become inactive as a result, that leads to all sorts of problems like heart disease and diabetes."

Just one injury can turn an active, healthy person into an inactive and unhealthy one.

Surgery can have the same result. "Many people develop pain after surgery or after illnesses like shingles," says Steven P. Cohen, MD, an anesthesiologist in the division of pain medicine at Johns Hopkins School of Medicine. If they don't get the pain treated promptly, he says, it can become chronic. And that can lead to yet greater ills.

"People who have chronic pain are exponentially more likely to have psychiatric illnesses like depression and anxiety disorders," says Edwards.

Another Price of Pain: Social Stigma

Pain has a high social cost for the sufferer, too. Because pain is a personal and subjective experience, it can lead to problems with family and co-workers. While you may be in terrible distress, the people around you just can't see or feel what you're going through.

"I think people in pain sometimes get unfairly dismissed by family and co-workers" Robert Bonakdar, MD, tells WebMD, "especially when they don't have an outward sign of suffering, like a cast or a bandage." Bonakdar is the director of integrative pain management at the Scripps Center for Integrative Medicine, La Jolla, Calif.

Cohen says this is toughest for people who suffer from painful syndromes, like fibromyalgia, irritable bowel syndrome (IBS), and complex regional pain syndrome.

"There's much less sympathy and understanding for these elusive syndromes," says Cohen. While Edwards says that the treatment for pain can often lead to as much stigma as the pain itself.

"When people hear that you're taking a narcotic pain reliever like methadone," he says, "they associate it with addicts." That can lead people to make some very wrong assumptions about you.

Are Health Risks the Price of Pain Relief?

Adding insult to injury, some pain medicines can pose health risks as well. The Cox-2 inhibitors Vioxx and Bextra are no longer available, removed from the shelves because of side effects. And we've all heard the stories about celebrities developing an addiction to narcotic painkillers like OxyContin and Vicodin.

Even a class of common over-the-counter painkillers -- NSAIDs (non-steroidal anti-inflammatory drugs) like aspirin, Advil, Aleve, and Motrin -- can pose a risk of gastrointestinal bleeding.

"The costs of treating complications from NSAIDs are more than $2 billion a year," says Cohen. "That's almost the same amount that's spent on these drugs."

It can leave someone in pain stuck in the middle. They want relief from their pain, but they're worried the treatment will be worse than the cure.

However, Cowan says that fears of addiction to narcotic painkillers are overstated. "People think that if you take a dose of OxyContin, you become a lifelong addict," says Cowan. "That's not true." She says that usually, when taken as prescribed, people will not have a problem.

Edwards adds that there's confusion between dependence on a drug and addiction to it.

"If you take any drug regularly, your body will get used to it," he says. "That's called dependence and it's very different from addiction. I'm an asthmatic and I'm dependent on my inhaler. Without it I'm on the floor gasping. But that does not mean I'm addicted to it."

Dependence can cause some symptoms of withdrawal when you stop taking the medicine. Your pain might worsen temporarily. But Edwards says there are ways of lessening these side effects if you're prepared for them.

Cashing In on Unconventional Chronic Pain Relief

Frustration has caused many people to seek out other ways of treating their pain. These include approaches like acupuncture, massage, biofeedback, focused relaxation, meditation, and other techniques. Many people find that they help.

"The statistics are staggering," says Bonakdar. "One survey of people with low back pain showed that 68% rated acupuncture and massage as 'very helpful.' Only 27% said that about seeing their doctor."

The demand for complementary treatments (sometimes called alternative medicine) has grown so much that traditional medicine has gotten in on the act. Across the country, new integrative or complementary medicine centers have appeared in prestigious hospitals. Many offer treatments that doctors would have scoffed at a few years ago.

However, you need to be careful. Some complementary pain treatments are risky. This is especially true of supplements, which can cause serious side effects or interactions.But it's very easy to ignore these dangers when you're suffering. "When pain has taken over your life, you stop thinking logically," says Cowan. "That's when you can fall into traps." Bonakdar says that some unscrupulous companies sell so-called miracle pain relievers to prey on the desperation of people in chronic pain.

"I see patients who wind up having a dozen different alternative practitioners, each prescribing a different supplement," Bonakdar tells WebMD. "No one knows what the other is doing. No one is keeping track."

Such a scattershot approach is unlikely to help. It's also more likely to cause side effects or interactions. If you're interested in complementary treatments, talk to your doctor, who can help you coordinate your treatment. And remember, he or she must always know about each vitamin, supplement, and complementary treatment you use.

Investing in You: Demanding to Feel Better

Experts do think we've made progress in the battle against chronic pain. Pain management has become a standard part of medical training. There's also a great deal of effort being put into pain research.

But pain specialists agree we haven't done enough.

"Pain management in the 21st century is more than just improving your rating on a [1 to 10] pain score," Cohen tells WebMD. "It's about how well you can function, your mood, your and your quality of life." It's about allowing someone to be active and productive again.

"I see patients who say that treatment has reduced their pain from an 8 to a 4," says Bonakdar. "That's great, but they're still depressed, they can't sleep, and they're mentally foggy. We need to treat the whole person, not just the pain."

As a pain sufferer, you have to speak up. The costs of pain -- emotionally and financially, personally and societally -- are simply too high to ignore. So tell your doctor about your pain. Explain how it limits you. If your treatment isn't working, ask what alternatives you can try.

"The bottom line is that people need to take a more active role with their health care providers and demand treatment," Cowan tells WebMD. "You have a right to have your pain managed."