Pain in Europe Netherlands

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Pain in Europe - Netherlands -
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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 (3,197)
• 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

• More than one in six (18) Dutch people suffer
  from chronic pain
• A third (33) of Dutch households are affected by
  chronic pain
• Regionally
• North/West 14.1
• East 16.7
• South/West 20.4
• South 18.2

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For Men and Women of All Ages

• Chronic pain is slightly more common in women
  (60) than men (40)
• Average age of sufferers is 51

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 6.5 years
• Almost a quarter had lived with pain for over 20
  years

Duration of Pain Reported by Chronic Pain
Sufferers Netherlands (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?

• 50 of sufferers report experiencing chronic pain
  all the time

Frequency Netherlands (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 (19)
• The most common location is the back

Most Common Causes of Pain Reported by Chronic
Pain Sufferers Netherlands (n251)

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?

• Over one in four (29) reported that their pain
  was so severe they could not tolerate any more

Tolerance Level for More Pain Netherlands
(n294)
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

• Two thirds (63) of chronic pain sufferers feel
  tired all the time
• Half of sufferers say being their pain leaves
  them
• Unable to function normally
• With difficulty thinking or concentrating
  clearly
• One in six 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
• Over half (56) feel that their pain impacts
  employment
• 14 working days a year are lost to pain (estimate
  on 6 month data)
• Sufferers report
• losing a job (29)
• and having been diagnosed with depression as a
  result of their pain (19)

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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,
  Neurologists and Rheumatologists are also seen
• Only 3 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
56 15 11 11 3 25 2 3 1 17 14
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

• Almost two thirds (61) 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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But There are Still Problems

• Many patients worry about their doctors
  willingness and ability to treat their pain
• 43 of chronic pain sufferers say their doctor
  never asks them about their pain
• And 45 dont believe their doctor knows how to
  control their pain
• In making a diagnosis or deciding on treatment,
  few doctors used pain rating scales (5
  unprompted)

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Especially with Diagnosis

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

• Two thirds of sufferers (64) are always willing
  to try new treatments
• But just over half (58) 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

• Just over half (57) of pain sufferers are
  proactive in treating their pain in some way,
  mainly via prescription medications
• A third (31) 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 Netherlands
(n300)
Use of Prescription Medications To Treat Chronic
Pain Netherlands (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

• NSAIDs (36) are most used class of pain
  medication
• Other commonly prescribed drugs are COX-2
  inhibitors (16) and weak opioids (14)
• Mean number of pills taken everyday is 3.7

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Use of Prescription Medicines

Weak Opioids
Strong Opioids
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 Netherlands (n181)
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

• Three quarters (79) 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 Netherlands (n298)
Adequacy of Pain Control from Medication
Netherlands (n119)
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

• Almost half (47) of chronic pain sufferers feel
  they never hear about new methods of treating
  pain
• Majority rely on newspapers, TV and magazines
• Just 5 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 Netherlands (n290)

Source Q36. Where do you hear about new
methods for treating pain?
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• Appendix

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WHO Analgesic Ladder

• By the mouth, by the clock, by the ladder, for
  the individual, with attention to detail

INCREASING 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