No pain, no gain?

According to a survey released by Pfizer in July, 74.3% of Japanese people with chronic pain, such as shoulder or back pain, feel they have to endure it. Medically, however, endurance can lead to chronic and treatment-resistant pain. It also has a physical and psychological impact. In fact, 13% of Japanese patients who suffer from chronic pain would experience difficulties in daily life or at work.

In July 2020, the definition of pain was revised for the first time in 41 years. Until then, the topic had not received much attention. Mr. Srinivasa N. Raja, MD, chair of the International Association for the Study of Pain (IASP) working group, motivated the revision by the need to better communicate the nuances and complexities of pain to improve the assessment and management of suffering. Pain is now defined according to six criteria:

• Pain is always a personal experience, influenced by biological, psychological, and social factors.
• Individuals learn the concept of pain through their life experiences.
• Pain is therefore distinct from nociception, in which nociceptors, pain-sensitive receptors that are present throughout the body, send a pain signal in response to an insult to the body.
• Although pain generally plays an adaptive role, it can have detrimental effects on social and psychological function and well-being.
• The relationship to the experience of pain must be respected.
• Verbal description is only one of the behaviors to express pain. Not communicating about pain does not mean that it is absent in humans and animals.

For Masahiko Shibata (Professor, Faculty of Health Sciences, Nara Gakuen University), who has been leading chronic pain medicine in Japan for many years, the fact that pain has been more clearly defined will have a significant impact on chronic pain medicine in Japan.

Indeed, while Japan has data on the awareness of patients taking morphine to alleviate cancer pain or on the rate of pain relief, there are no large-scale surveys or studies of patients with chronic pain, nor are there baseline data to improve the quality of care to free many people exposed to pain.

A recent Internet survey collected 21,621 responses from 30,000 individuals surveyed. The distribution of this number by gender was almost equal between men (48.3%) and women (51.7%). In a second phase, 18,300 people (9,150 men and 9,150 women) were selected to determine those who met the 5 criteria* for screening for chronic pain. The results showed that 2,455 (13.4%) had chronic pain. The 18- to 29-year-olds represented 9.2%, the 30 to 49 year olds 12.9%, and the 50 year olds and over 15.4% of the total, which establishes the average age of the chronic pain sufferers at 46.3 years, with no significant differences according to sex. The most frequent symptom was low back pain (58.6%), followed by shoulder pain (38.7%) and headache (29.7%)**.

The results show that 95.4% of patients were treated for pain by physicians who also treated the underlying disease. Orthopedics was the most requested service (45%), followed by internal medicine (21.6%), massage and osteopathy (15.1%). The use of physiotherapy to treat pain was therefore preferred by the sample considered. Of these 2,455 people with chronic pain, 34.5% were forced to temporarily interrupt their activity (work, studies, household chores).

Pain management is now considered to be the fifth vital sign for improving the quality of treatment. In Japan in particular, where the working population is greater than the total population of France, and where there are 36 million people over the age of 65, this is a real issue, both economically and socially.

* 1- Men and women 18 years of age and older, 2- Those who have experienced pain for at least six months due to illness or health, 3- Those who have experienced pain in the past month, 4- Those who have experienced pain at least twice a week, 5- A 10-point pain scale (1 = no pain at all, 10 = the worst pain imaginable)

** Osteoarthritis/arthritis of the knee, herniated discs, bone and muscle diseases were the most common causes of back pain.