What Is the Impact of Untreated and Under-treated Pain?

Pain is the leading public health problem in this country and the most common symptom that leads to medical care. Pain is the most common reason people seek medical care [7]. Acute pain commonly occurs post-operatively, following trauma, or secondary to severe illness; more than 50% of patients report severe to intolerable pain secondary to injury or post-surgery [9]. Surgery and trauma also account for 25% of the burden of chronic pain [14]. Chronic pain currently affects one in five adults, is more prevalent among women and the elderly, and is associated with physically demanding work and lower education [14]. Chronic-malignant pain, which accompanies terminal illnesses such as cancer, HIV/AIDS, multiple sclerosis, end stage organ failure, and chronic obstructive pulmonary disease [15], is a significant cause of disability [10]. As many as 60%–90% of patients with advanced cancer or in the terminal phases of AIDS experience moderate to severe pain [6], and pain is the second most common complaint of the more than 33 million individuals living with HIV/AIDS in the developing world [9]. Chronic-non-cancer pain (CNCP), which includes neuropathic, musculoskeletal, and visceral pain, accounts for 70% of pain experienced by older patients [15]. Untreated pain has a profound impact on quality of life and can have physical, psychological, social, and economic consequences. Inappropriately managed acute pain can result in immunological and neural changes, which can progress to chronic pain if untreated [16]. Clinical outcomes of untreated postoperative pain include increased risk of atelectasis, respiratory infection, myocardial ischemia, infarct or cardiac failure, and thromboembolic disease [16]. Common sequelae of untreated chronic pain include decreased mobility, impaired immunity, decreased concentration, anorexia, and sleep disturbances [9],[10]. Patients with chronic pain often experience social isolation, dependence on care givers, and impaired relationships with friends and family [14], and are four times more likely to experience depression or anxiety than those without pain [10]. The financial burdens of untreated chronic pain—absenteeism, income loss, healthcare costs, and workers compensation—place the same strain on countries as cancer and cardiovascular disease [9]. In the United States, the annual cost of untreated pain is reported to be between US$560–US$635 billion [17]. It has been argued that many of the conditions causing the greatest global disease burdens, such as depression and trauma secondary to motor vehicle collisions or falls, do so through acute or chronic pain [14]. The prevalence of untreated pain is likely to increase as the population ages in many developed nations, and with the increasing global burden of chronic disease and HIV/AIDS [12]. Global inequalities will also likely widen. More than 90% of HIV patients are located in developing countries, and the WHO estimates that 70% of the 20 million new cancer cases predicted by 2020 will occur in the developing world [12]. The need for pain treatment in these countries is exacerbated by their relative lack of access to curative or palliative care, such as surgery and anti-retroviral drugs [12]. Even in countries with advanced health care systems, pain is often under-diagnosed and undertreated [9], particularly among the poor, elderly, mentally ill, children, women, and racial/ethnic minorities [18],[19]. There is also a lack of training for pain management among vulnerable populations, including children and the elderly, leading to increased risk of untreated pain [15]. For these reasons, the Institute of Medicine recently called for a “cultural transformation” in the approach to pain management in the US [17]. Pain management is complex, and certain types of pain, including CNCP, may require multimodal approaches that combine pharmaceutical and non-pharmacological therapies [15]. Nevertheless, current pharmaceutical interventions are generally effective and, in high-income countries, a cheap and readily available means of reducing acute and chronic malignant pain. Opioids are effective in treating moderate to severe pain and have been included on the WHO Essential Medicine list since 1986 [5]. Yet inequalities in opioid availability are widespread and well-documented. Morphine and other strong opioids are unavailable in over 150 countries [15]. Even when they are available, opioids often cost more in low- and middle-income countries [10],[12]. By one estimate, 600 million people alive today will experience negative health impacts due to untreated pain. Definition by: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614505/