Pain in Europe Sweden

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Pain in Europe - Sweden -
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The Pain in Europe Research

• Largest survey ever undertaken into pain
• Interviews with 46,000 people across Europe
• Striking results demonstrate the devastating
  impact of chronic pain
• Data submitted to peer review journal for
  publication

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Objectives

• Estimate the prevalence of chronic pain
  conditions across Europe
• Understand and quantify the sources and causes of
  chronic pain
• Explore the demographics of sufferers
• Explore the impact of pain on sufferers quality
  of life
• Understand current treatment practices levels
  of satisfaction
• Explore the attitudes of sufferers toward and
  experiences with pain

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Methodology
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Methodology

• CATI (Computer Assisted Telephone Interviewing),
  Random dialling
• Screener Questionnaire (2,563)
• Determine the prevalence of chronic pain by
  country
• Detailed Questionnaire (300)
• Inclusion Criteria
• Adult (18 years old or older)
• Suffered pain for at least 6 months duration
• Has experienced pain within the past month
• Experienced pain at least several times a week
• Pain intensity gt5/10
• Has not participated in medical studies.

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• The Data

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Prevalence
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Pain - A Widespread Problem

• 18 of Swedes suffers from chronic pain
• A third (31) of Swedish households are affected
  by chronic pain
• Regionally
• North 23.2
• Center/North 19.3
• Stockholm 16.0
• Center East 16.7
• Center West 18.5
• South 17.3

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For Men and Women of All Ages

• Women (54) are as likely as men (46) to suffer
  from chronic pain
• Average age of sufferers is 52

Source SQ4. Record sex from voice. SQ5. How
old were you on your last birthday? US Census
Bureau International Database (IDB), Summary of
Demographic Information. October 2002 estimates.
http//www.census.gov/ipc/www/idbnew.html
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Patients Forced to Live in Pain

• On average, sufferers had lived with chronic pain
  for 9 years
• Almost a fifth had lived with pain for over 20
  years

Duration of Pain Reported by Chronic Pain
Sufferers Sweden (n300)

Source SQ6. For how long have you suffered
from pain due to your illness or medical
condition?
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How Often Does it Hurt?

• 33 of sufferers report experiencing chronic pain
  all the time

Frequency Sweden (n300)
Source SQ8. How often do you experience pain?
(Read list) SQ7. When was the last time you
experienced pain? (Read list)
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Nature of Chronic Pain
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Where does it hurt?

• The most frequent cause of chronic pain is
  arthritis / osteoarthritis (27)
• The most common location is the back

Most Common Causes of Pain Reported by Chronic
Pain Sufferers Sweden (n237)

Source SQ11. Where is your pain located? SQ12.
Please tell me the illness or medical condition
that is the cause of your pain. Q1. Is your
pain caused by?
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And How Much?

• One third (36) reported that their pain was so
  severe they could not tolerate any more

Tolerance Level for More Pain Sweden (n298)
Source Q4. Thinking about the intensity of
your pain when it was at its worst, which of the
following statements best describes your
tolerance level of this pain?
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Quality of Life
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Chronic Pain is Insidious

• Because of their pain, two thirds (64) of
  sufferers have difficulty thinking or
  concentrating clearly
• Half of chronic pain sufferers
• Feel tired all the time
• Feel helpless
• One in five say the pain is sometimes so bad they
  want to die

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Chronic Pain is Insidious

HigherAgree more strongly with the
statement Source Q37. Now we would like to
understand how pain affects your life. I am
going to read a list of statements that could be
used to describe how people who are experiencing
pain think and feel about it. For each statement
I read, please think about yourself and your own
pain and tell me how much you agree or disagree
with each statement using a 5-point scale where
1Disagree Completely, 2Disagree Somewhat,
3Neither Agree nor Disagree, 4Agree Somewhat,
and 5Agree Completely. (Read list)
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And Can Devastate Lives

• Chronic pain has an undoubted impact on the daily
  lives of sufferers
• Chronic pain impacts on daily activities such as
  lifting, exercising, sleeping and working outside
• Nearly half (47) feel that their pain impacts
  employment
• 14 working days a year are lost to pain (estimate
  on 6 month data)
• A quarter of sufferers report
• losing a job (24)
• and having been diagnosed with depression as a
  result of their pain (24)

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And Can Devastate Lives

Source Q6a. Have any of the following ever
happened as a result of your pain? (Read list)
Q6b. Have you ever been diagnosed with
depression by a medical doctor as a result of
your pain?
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Doctors and Patient Relationships Revealed
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Patients See Different Clinicians But Rarely Pain
Specialists

• Consultations were most frequently with GPs
• And to a lesser degree Orthopaedists are also
  seen
• Only 2 report seeing an actual pain specialist
  (unprompted)

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Chronic Pain Patients See Many Different
Clinicians

• Physician Specialty

Who See
General/Family Practitioner Orthopaedist/Orthopaed
ic Surgeon Rheumatologist Neurologist//Neurosurgeo
n Internist Physiotherapist General Surgeon Pain
Management Specialist Osteopath Other When
asked specifically whether ever been to a pain
management specialist
69 12 3 3 0 3 3 2 0 17 12
Other includes Alternative Medicine/Homeopathy,
Anesthaesiologist/Anesthaetist, Cardiologist,
Chiropractor, Ear Nose Throat, Gastroenterologist,
Gynecologist, Hematologist, Infectious Disease,
Oncologist, Ophthalmologist, Physical Medicine,
Plastic Surgeon, Psychiatrist, Pulmonoloigst,
Radiologist, Sports Medicine, and
Urologist. Source Q12c. What kinds of doctors
are you currently seeing specifically for your
pain? Q12d. Have you ever been to see a pain
management specialist?
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Doctors Defended

• Just over half (57) of sufferers are very or
  extremely satisfied with the doctor who treats
  their pain
• And have seen them once in last six months

Higher better Source Q14d. How satisfied
are you with the doctor who currently treats your
pain? (Read list) Q14e. Why do you say you are
not very/not at all satisfied with the doctor who
currently treats your pain?
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Because of Communication Problems

• Many patients worry about their doctors
  willingness and commitment to treating their pain
• A quarter (26) of chronic pain sufferers believe
  that their physicians are more focused on their
  illness than their pain
• In making a diagnosis or deciding on treatment,
  few doctors used pain rating scales (3
  unprompted)
• Most discussions are patient initiated

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Because of Communication Problems

Source Q37. disagree with each statement using
a 5-point scale where 1Disagree Completely,
2Disagree Somewhat, 3Neither Agree nor
Disagree, 4Agree Somewhat, and 5Agree
Completely. (Read list) Source Q13c. How does
the doctor who generally treats your pain
determine how much pain you are in? Q14a. Has
any doctor or medical professional ever scored
you on a pain scale?
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Feelings about Treatments

• Three quarters (75) are always willing to try
  new treatments
• But a third (37) are worried about potential
  side effects of pain medication

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Feelings about Treatments

HigherAgree more strongly with the statement
Source Q37. Now we would like to understand
how pain affects your life. I am going to read a
list of statements that could be used to describe
how people who are experiencing pain think and
feel about it. For each statement I read, please
think about yourself and your own pain and tell
me how much you agree or disagree with each
statement using a 5-point scale where 1Disagree
Completely, 2Disagree Somewhat, 3Neither Agree
nor Disagree, 4Agree Somewhat, and 5Agree
Completely. (Read list)
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Use of Prescription Medicines

• Pain sufferers are proactive with 65 of chronic
  pain sufferers treating their pain in some way,
  mainly via prescription medications
• A third (36) have tried then stopped taking
  prescription pain medication

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Use of Prescription Medicines
Chronic Pain Sufferers Reporting Currently
Treating Their Pain in Any Way Sweden (n297)
Use of Prescription Medications To Treat Chronic
Pain Sweden (n300)
Source Q11a. Is your pain currently being
treated in any way? Q15a. Have you ever taken
prescription medicine for your pain? Q16a. Are
you currently taking prescription pain medicine?
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Use of Prescription Medicines

• Weak opioids (36) are most used class of pain
  medication
• Other commonly prescribed drugs are NSAIDS (27),
  and paracetamol (26)
• Mean number of pills taken everyday is 2.7

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Use of Prescription Medicines

Source Q18. Which prescription pain medicines
are you currently taking for the specific pain we
have been discussing?
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Use of Non- Prescription Medicines
Non-Prescription (OTC) Classes and Medications
Chronic Pain Sufferers Report Currently Using for
Pain Sweden (n171)
Source Q18. Which non prescription pain
medicines are you currently taking for the
specific pain we have been discussing?
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Alternative Therapies

Source Q28. What other methods, remedies or
treatments, apart from medications have you ever
tried to relieve your pain for the medical
condition or illness we have been discussing?
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How Patients Rate Treatments

• Nearly three quarters (30) of pain sufferers
  feel their treatment is inadequate at times
• Chronic pain sufferers report that there is
  considerable room for improvement in the
  effectiveness of pain treatments

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How Patients Rate Treatments
Pain from Activity Sweden (n296)
Adequacy of Pain Control from Medication
Sweden (n137)
Source Q21. Do you ever experience an increase
in pain during the day as a direct result of an
activity you did? Q20. Are there ever times
when your pain medicines are not adequate to
control your pain?
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Learning About New Pain Treatments

• Half (50) of chronic pain sufferers feel they
  never hear about new methods of treating pain
• Majority rely on newspapers, TV and magazines
• Just 9 surf the Net for new options

Source Q36. Where do you hear about new
methods for treating pain?
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Learning About New Pain Treatments
Where Chronic Pain Sufferers Report Hearing About
New Pain Treatments Sweden (n228)

Source Q36. Where do you hear about new
methods for treating pain?
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Data Weighted for Gender Age
The weighting procedures within each country
(region) used a cell-based weighting scheme with
2 gender categories by 7 age categories, creating
14 cells which were balanced to the population
figures obtained from the U.S. Census Bureau
International Database (IDB), summary of
demographic information, October 2002 estimates.
A balancing procedure was adopted to adjust the
sample cell proportions to the population cell
proportions.

• The age groupings were as follows

• 61 70 years
• 71 80 years
• 81 years and older

• 18 30 years
• 31 40 years

• 41 50 years
• 51 60 years