HPE Chronic pain – part one - Page 5

and impotent). A high number of the relatives of those with chronic pain also suffer sadness and anxiety and withdraw from social activities themselves. 21 Effects on health care systems Pain accounts for considerable expenditure and consumption of resources in primary care. 27,28 In a study by Breivik et al,1 60% of chronic pain patients reported that they had visited their clinician 2–9 times in the months before the study commenced and that 11% had visited at least ten times. A total of 70% visited their GP, whereas only 2% were treated by pain specialist. People who leave their employment or lose their job as a result of pain, and those who perceive their pain affects their family, are those who use the healthcare systems the most. 21 It has also been shown that pain is often adequately diagnosed and treated in primary care, resulting in excessive appointments and overuse of healthcare resources. 21 Conclusions Based on the definition of disease, most chronic pain can be considered as a disease in its own right. The new ICD-11 classification acknowledges that chronic pain is a disease in its own right by introducing the coding of ‘chronic primary pain’. Yet, at the same time many patients with ‘secondary chronic pain’ have emotional distress and important interference with daily activities and social participation. As such, they fit into the concept of pain as a disease while their pain can be a symptom of an underlying disease. Chronification should be considered as a continuum where initially, pain could be a symptom, but can develop into a disease. Therefore, disease-specific treatment paradigms, focusing on multimodal strategies, need to be applied, which might differ from those were chronic pain is merely a symptom of an underlying chronic condition. Because of the high prevalence of chronic pain and the resultant serious medical and non-medical consequences, effective health care policies, acknowledging pain as a public health priority, and multidisciplinary treatment strategies to prevent and manage pain and minimise the disability that it causes, are required. In a study comparing health-related quality of life (HRQoL) in patients with acute pain and chronic pain with those without pain, chronic pain patients received the worst score in all dimensions of HRQoL. 24 Effect on work Studies have demonstrated that that absenteeism, presenteeism and early retirement related to chronic pain present a significant burden as least as great as conditions that are typically prioritised as public health concerns. 25 In the 45–65-year-old age group, low back pain is one of the most frequently cited medical reasons for loss of work. 26 Effect on social relationships and family Chronic pain can restrict a person’s leisure activities and social interactions. Family members often find that they need to undertake care duties and must become involved in decision making regarding medical treatment and consequently suffer negative feelings (including feeling overburdened, frustrated References 1 Breivik H et al. 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