• 20% of U.S. population suffers from chronic pain
• 50 million Americans are partially or totally disabled by pain (17.5%)
• 16%-29% claim to have back pain present on at least 50% of the time
• 22% of work related injuries involve back pain
• 1% of the workforce is chronically disabled due to back problems
• About 25% of chronic pain sufferers wait at least 6 months before going to a doctor for pain relief because they underestimate the seriousness of it and think they can "tough it out"
• Approximately 40% of those who see doctors are no longer going to them because they think either there is nothing more a doctor can do or, in one way or another, they can deal with it themselves
• 55% of chronic pain sufferers, who classify their pain as moderate, say their pain is under control. 39% of those with severe pain claim control. It is important to note that control does not vary significantly by the age or sex of the sufferer
• Of those with severe pain, 70% took at least 6 months of pain treatment to classify it as under control
• 70% of those in severe pain currently go to doctors for pain relief. Additionally, significant numbers of these are more likely to require emergency room visits, hospitalization or psychological counseling to treat their pain
• Almost 50% of pain sufferers have changed doctors since their pain began, and almost 25% of those have changed at least 3 times. This level of frustration is significantly higher among those with very severe pain. The primary reason for the change is still having too much pain after treatment
• 22% of chronic pain sufferers have been referred to a specialized treatment program for their pain. Only 3% of chronic pain sufferers were denied access by a managed care gatekeeper or workman's comp program after such a referral
• Almost 75% of sufferers perceive Over the Counter (OTCs) as being effective for the relief of moderate pain
• The majority of severe pain sufferers favor narcotic, anti-depressants and anti-seizure medications
• Regardless of severity, the most common medications being used for treatment of chronic pain are OTC's

Pain's Impact on the quality of life:

• Exercise-81%
• Sleeping-79%
• Leisure activities-67%
• Household chores-65%
• Socializing-65%
• Walking-59%
• Sex-54%
• Concentrate-49%
• Functioning at work-41%
• Relationship with family-31%

Pain's Impact on emotional well being:

• Irritable-35%
• Listless-27%
• Depressed-25%
• Feel useless-18%
• Unable to cope-11%

• 10% of chronic pain sufferers have at one time turned to alcohol for relief. This occurred in almost one of every five middle-aged (34-49) adults and more frequently in men(16% vs. 7% of women)
• As expected, chronic pain patients report that their closest family members (78%) and friends(75%) provide strong support
• 63% perceive their doctors as being supportive
• 48% perceive employers as being supportive
• 15-25% of injuries are covered by worker's compensation and 30 - 40 % of compensation payments are related to low back pain
• 87% of compensation claims are for strains and sprains, 72% of which are due to overexertion in lifting and handling
• healthcare costs of low back pain (1990) = $24.30 billion
• annual combined cost of back pain related medical care and disability compensation may reach $50 billion in the U.S. by the year 2000.

Back pain with disc herniation on MRI

• 90% of cases will slowly improve over six weeks
• 10% may appear to require surgery
• 2% may really have pain due to disc herniation
• 8% may have pain due to other causes (facets, annular tear, myofascial)

Symptomatic Disc Herniation

• Return to work better predicted by job satisfaction, psychological traits, and physical findings than pathoanatomic findings
• Imaging studies only weakly predict the need for or outcome of surgery

Osteoporosis

• 25 million Americans have osteoporosis
• 100% incidence of osteoporosis in females 75 years old or greater
• From the 4th to 5th decade of life both males and females have a 0.3 - 0.5 percent decrease in bone mass annually
• There are approximatly 25,000 hip fractures annually
• Females over 50 have a 40% risk of fracture during their lifetime

Cancer Pain Epidemiology

• 15% of patients with non-metastatic cancer have pain
• 30% of patients with metastatic disease report pain that interferes with their activity and/or requires analgesics
• 40% of cancer patients in an acute care facility have pain
• 60% - 90% of terminal cancer patients have pain
• 25% of cancer patients internationally die in severe pain

Common pain inducing malignancies:

ADULTS	PEDIATRICS
Breast	Primary Bone
Lung	Hepatoma
Primary Bone	Neuroblastoma
Head and Neck

Undertreatment of cancer pain

• 49% of oncologists rate their pain management as fair, poor, or very poor
• in 76% of cases of undertreatment this was due to inadequate pain assessment
• in 62% undertreatment was due to patient reluctance to report pain
• in 61% physician reluctance to prescribe opiates was a significant contributing factor

Narcotics and addiction

• 5% of patients taking narcotics for non cancer pain become addicted
• 1% of patients taking narcotics for cancer pain become addicted