Quarter of a million people in Ireland fail to seek medical help for debilitating back pain

Under-diagnosed and unmanaged back pain causes up to 26 days lost productivity a year in Ireland's under 50s

Quarter of a million people in Ireland fail to seek medical help for debilitating back pain

Under-diagnosed and unmanaged back pain causes up to 26 days lost productivity a year in Ireland's under 50s[1]

Up to a quarter of a million people in Ireland who suffer from nerve related back pain do not seek medical assistance because they believe their condition is not serious enough to warrant treatment according to a new survey released by Chronic Pain Ireland and Pfizer[1]. This is despite the issue having a significant impact on patients’ quality of life and their careers.

The new research reveals that this type of back pain is frequently under-diagnosed or misdiagnosed - despite the fact that it affects a significant amount of the estimated 400,000 people suffering from chronic pain in Ireland - and it can be managed when correctly diagnosed. Nearly half (48%) of patients with nerve related back pain do not seek medical advice for their pain according to the survey.[1]

The findings of the survey have prompted Irish pain experts to urge those suffering from this debilitating condition to seek help from their GP as early as possible to ensure that they have access to appropriate treatment options.

Doctors warn that chronic pain of this kind can damage people’s quality of life, making it difficult for them to work and socialise. It can also lead to feelings of depression and indeed can impact on sexual relationships.

The Irish survey, which was part of a wider analysis commissioned by Pfizer across 10 European countries[1], found that:

  • Lower back pain was the most common type of back pain (40%) in the Irish sample
  • 48% of the Irish people surveyed had suffered from back pain for more than five years
  • 68% suffered from back pain at least once a week or more

The survey found that people took an average of eleven days away from work as a result of this type of pain and their productivity was reduced for 26 days[1]. The prevalence of nerve related back pain in people of working age is particularly significant, as 80% of patients affected are under 50 years of age[1]. 50% of employers were sympathetic towards people taking time away from work and 66.7% of them did not raise reduced productivity as an issue. Productivity at work is compromised to a certain extent for more than 80% of patients with nerve related back pain.[1]

The total costs of chronic pain are estimated at €5.34bn per year, which is 2.86% of the Irish GDP in 2008.[2] Chronic pain is defined as pain which lasts longer than twelve weeks. In 2002, the national annual cost of claims for personal injury was in excess of €2 billion and 22% of these costs were due to back pain caused by poor manual handling.[3]

As well as the cost to the healthcare system, chronic pain also results in other costs to the Exchequer. The cost for disability benefit for chronic low back pain totalled €348 million in 2002[3]. Twenty seven percent of people who receive income support do so due to chronic back pain, making it the highest single reason for people claiming income support[3].

The survey echoes the findings of previous research commissioned by Pfizer in 2010 which showed that one in three people who have chronic pain are struggling with their condition and fear that their illness and absences from work may mean they lose their job[4]. 42% of respondents said their employers and peers doubted the existence of their pain and a quarter had been accused of using pain as an excuse not to work[4].

Ms Gina Plunkett, Chairperson of Chronic Pain Ireland, said:

"The perception that people with chronic pain can't or don't want to work is wrong. Many pain sufferers are productive, talented and committed employees with the same aspirations and ambitions as people without chronic pain and shouldn’t be limited by their condition. Yet the system is failing many people living with pain - preventing them from playing their full part in the nation's workforce.

"As well as the physical and emotional problems it causes to sufferers, chronic back pain represents a tangible cost to employers, society and the healthcare system. It is important that people talk to their doctor at a very early stage about their pain because describing the pain clearly enables quicker diagnosis and more appropriate treatment."

"People living with debilitating back pain, nerve related back pain or any type of chronic pain need the full support and understanding of family members, friends, work colleagues and employers."

Dr Paul Murphy, St Vincent’s University Hospital, Head of Education for Faculty for Pain Medicine in Ireland, commented:

"The under and misdiagnosis of this type of back pain has a significant negative impact on the daily lives of thousands of Irish people. Back pain is typically treated as a routine condition by managing physicians, despite their fears that it will lead to many repeat visits and unresolved complications for patients. We now have a range of effective screening tools available and coupled with following guidelines closely, Irish doctors have a responsibility to quickly diagnose and find the right treatment to ease the burden of chronic back pain."

Over half of patients and the majority of patients consulted their GPs within four weeks[1]. Pain was the main reason for seeking medical advice and seven out of ten patients took painkillers before consulting a doctor.[1]

Describing back pain clearly can help enable accurate diagnosis and treatment[5] and the research revealed a self-proclaimed inability of patients to accurately describe back pain with a neuropathic component and of physicians failing to accurately segment this kind of pain from other, less treatable forms of back pain.[1]

84.6% of patients received an explanation for their back pain and nearly 40% of them were offered the term "lower back pain" as an explanation for their condition[1]. However, discrepancies between terms used to describe nerve related back pain by healthcare professionals and patients revealed major communication issues between healthcare professionals and patients. While doctors favour terms such as ‘like electric shock’, ‘painful pins and needles’ and ‘burning’, patients describe the pain as ‘persistent’, ‘sharp’ or ‘shooting’.[1]

Other findings from the research include:

  • GPs only refer cases that are irresponsive to treatments or that they regard as too serious or complex. Up to 20% of patients were referred to another speciality last year. GPs mainly refer patients to pain specialists (89.5%) and neurosurgeons (73.7%)[1].
  • A majority of patients (61.6%) had to wait for more than one month for a specific diagnosis. Nearly a quarter of patients are still waiting for an effective treatment[1].
  • Patients were mainly given pain relief medications (53.8%) as a treatment for their nerve related back pain, but time off work/rest (30.8%) was also recommended.

All healthcare professionals considered nerve related back pain to have severe or moderate impact on patients’ quality of life and they all agree that patients’ ability to go to work is affected by nerve related back pain[1].

  • Healthcare professionals reported that 69% of nerve related back pain patients requested time away from work last year[1].
  • Nerve related back pain causes patients to feel tired (66.7%) and affects their ability to do sports/hobbies (44.4%)[1].
  • Almost half (48%) of patients gave up hobbies to cope with their back pain[1].

Professor Josep Darba, a specialist in health economics from the University of Barcelona and co-designer of the research, commented:

"Back pain with a neuropathic component is a major challenge for European healthcare systems costing an estimated €5.34 billion in Ireland alone[2]. For the first time, this research highlights shortcomings in the description, understanding and management of the condition. Through greater understanding of how this pain presents and manifests itself, better diagnosis and management choices can be made, which stand to have a tangible effect on the existing health-economic burden."

References

1. Opinion Health, Neuropathic Back Pain. Date of preparation: August 2011 (Ireland, 20 HPCs, 25 patients, 1 key opinion leader)

2. http://www.jpain.org/article/S1526-5900(11)00816-9/abstract. Accessed February 2012.

3. Fullen B, Hurley DA, Power C, Canavan D, O'Keeffe D. The need for a national strategy for chronic pain management in Ireland. Ir J Med Sci. 2006 Apr-Jun;175(2):68-73.

4. Pain Proposal: A European Consensus Report. EFIC, EFNA & Pfizer (Date of preparation: September 2010)

5. Doth AH, Hansson PT, Jensen MP et al. The Burden of Neuropathic Pain: A Systematic Review and Meta-Analysis of Health Utilities. Pain. 2010; 149: 338-344.

Published: 29th February 2012.


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