20 percent of people with chronic pain do not seek help

A Rochester-based study has found more than 20 percent of people with chronic pain did not seek physician help for their pain. The study supports the opinion of many physicians that a large segment of patients has an unmet need for pain care.

Increased media attention and physician education are recommended to decrease the number of "silent sufferers," according to the study. Published in the February issue of Mayo Clinic Proceedings, the study looked at 3,575 people. Of the 2,211 respondents who reported pain of more than three months' duration, 22.4 percent (497) stated that they had not informed their physician about their pain. The survey covered a cross-section of residents of Olmsted County, Minn., from March through June 2004.

It is unclear whether the reasons for not seeking treatment are limited to minor impact of pain on the person, or for other reasons such as poor previous experiences with pain care, perceived lack of effective treatments, and barriers to health care; lack of medical insurance, for example.

The importance of pain management has gained increasing recognition in the last decade. In 1995, the American Pain Society declared pain to be the fifth vital sign, a designation to increase pain awareness among health care professionals.

The rapid increases in pain medicine prescription hint at a population of patients with unmet pain needs, according to the study.

Barbara Yawn, M.D., an Olmsted Medical Center physician and an author of the study, says, "Identification of patients in pain is essential to successful pain care. Despite significant efforts, successful pain care clearly is not happening. Physicians have a responsibility to ask their patients about chronic pain."

Pain's health impact on society is significant. Pain sufferers report that their pain interferes with their general activities and sleep. Approximately 25 percent of "silent sufferers," those not telling their physician about their pain, indicated at least moderate interference with both general activity and sleep. A larger proportion of vocal sufferers (43.2 percent) showed comparable levels of interference. In general, the location of the pain had little effect on whether the patients reported their pain. The study found that chronic pain suffers who do not seek treatment tend to be younger men whose pain has less impact on their usual activities.

Other researchers included Emmeline Watkins, Ph.D., from the Department of Epidemiology at AstraZeneca, and Peter Wollan, Ph.D., from Olmsted Medical Center, and Joseph Melton, M.D., from Mayo Clinic. The study was supported by a grant from AstraZeneca.

A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally.

Articles are available online at www.mayoclinicproceedings.com.