Highlighted in the chief medical officer’s 2008 annual report was that some 7.8 million people are affected by pain and the numbers continue to rise.

People with chronic pain account for a significant proportion of GP appointments each year and are relatively high users of accident and emergency and outpatient services. But it is the indirect costs which have the biggest impact.

In 1998, it was estimated that the cost to the UK of back pain alone was £12.3 billion and the main part of this cost (£10.7 billion) was due to work days lost with chronic pain being the second most common reason for claiming incapacity benefit. But in Dame Carol Black’s 2008 report Working for a healthier tomorrow one struggles to find any significant reference to chronic pain.

With chronic pain having such a major impact on both people’s lives and the economy, the CMO’s report concluded that much more needed to be done to widen access to high quality pain services which in turn would improve the lives of millions of people.

Picking up on this challenge, an All-Party Parliamentary Chronic Pain Group was established in May 2009 and in November 2009 met with the relevant health minister to discuss the Department of Health’s progress with implementing the CMO’s recommendations. Not much progress seemed to have been made and a BBC news report in March this year reported comments from a frustrated Chronic Pain Policy Coalition that perhaps it was time that chronic pain was recognised as a disease in its own right.

Europe meets to discuss the issue

So it was of great interest that many of the UK protagonists in this area decamped to Brussels in May where they were joined by many more interested parties from across Europe. Thesymposium brought together delegates from 28 European countries to examine more closely the societal impact of pain and its implications for healthcare policy makers.

The symposium  was organised by the European Federation of International Chapters (EFIC) of the International Association for the Study of Pain, their first such EU-wide meeting and supported by Grünenthal GmbH.

“Pain is a significant health problem that affects millions of people in Europe,” declared Giustino Varrassi, EFIC’s President at the symposium opening.

He added, “And it must be addressed not only in terms of direct costs to national health care systems but also in terms of the wider societal costs, costs on welfare systems and the negative impact on the economy”.

Many speakers suggested that pain was simply not being recognised as an important public health issue by national health care systems and that by improving this situation, this would not only reduce healthcare expenses but also increase productivity, reduce incapacity benefits and add to exchequer revenues. And there were also suggestions that because of its high prevalence and impact on patients and society, treatment should be recognised as a health quality indicator for healthcare systems. And further, that freedom of pain should be regarded as a universal human right because of the tremendous human suffering resulting from it.

A whole systems approach

One notable presentation was from Professor Ceri Phillips of the University of Swansea who felt that there was a need for a whole systems perspective on chronic pain.

Professor Phillips emphasised that chronic pain impacts not only the individual (quality of life) and healthcare systems (A&E) but also on organisations (absenteeism) and the welfare system (benefits). But “brick walls” often exist between health and work systems, operating as “parallel universes with mismatched agendas and conflicting targets”. More integrated approaches were therefore needed.

In conclusion he said, “It is vital that pain and its management is moved higher up in the political agenda and featured more prominently in government policies. It is also essential for a joined-up cross-agency approach to be adopted, involving all those who have an interest in preventing ill-health, treating ill-health and rehabilitating those who have suffered from pain”.

Yet decision makers simply do not seem to be aware of the size of the problem with societal costs possibly being as high as 1.5 per cent GDP and consuming as much as 22 per cent of healthcare expenditure. Furthermore, delegates were told that the results from an EU-wide survey on the impact of pain in the big 5 EU countries suggested real healthcare inequalities as regards the management of chronic pain in lower socio-economic groups and socially disavantaged groups. 

More and more countries are now collecting data on pain treatment and direct/indirect costs and outcomes but there is still insufficient focus on the impact of pain on work related activities. Better education and implementation of pain guidelines are also necessary. But this “bunker mentality” to different budgets still makes it very difficult to take an integrated approach to pain treatment.

However, some countries are now investing in better care for patients. For instance, a new law in France has made pain relief a fundamental right and the Scottish Government has recently committed to recognise chronic pain as a long term condition. There is now a chronic pain czar and chronic pain managed clinical networks are being rolled out across the country with clear referral pathways from primary to tertiary care.  

So what to do?

With this huge apparent unmet need in England, maybe it is time the new goverrnment looked at chronic pain. If chronic pain is going to be a disease in its own right, maybe it needs a classification code? If it is going to be a basic human right, perhaps one should suggest to the Care Quality Commission that it is in its essential standards of quality and safety. If it is to move to a priority status, maybe someone should suggest this to the National Quality Board? It could also be incorporated into QOF.

Chronic pain is undoubtably a big public health issue but perhaps at a time of healthcare recession and financial cuts maybe it will just continue to live behind closed doors and in live in the the shadows and continue to be the “invisible disease.”