Pain in Europe Survey Pan-European Results The Pain in Europe Research Largest survey ever undertaken into pain - Prevalence data based on >46,000 interviews - Attitudinal data from almost 5,000 interviews Striking results demonstrate the devastating impact of chronic pain Objectives Estimate the prevalence of chronic pain conditions across Europe Understand and quantify the sources and causes of chronic pain; Explore the demographics of sufferers; Explore the impact of pain on sufferers’ quality of life Understand current treatment practices & levels of satisfaction Explore the attitudes of sufferers toward and experiences with pain Methodology Methodology CATI (Computer Assisted Telephone Interviewing), random dialling Screener Questionnaire (2,900 average) - Determine the prevalence of chronic pain by country Detailed Questionnaire (300) Inclusion Criteria - Adult (18 years old or older); - Suffered pain for at least 6 months duration - Has experienced pain within the past month - Experienced pain at least several times a week Pain in Europe: Countries Covered Phone Screen Structured Phone Interviews UK 3,800 300 France 3,846 Germany Phone Screen Structured Phone Interviews Netherlands 3,197 300 300 Belgium 2,451 301 3,832 302 Finland 2,004 303 Italy 3,849 300 Ireland 2,722 300 Spain 3,801 301 Switzerland 2,083 300 Poland 3,812 300 Austria 2,004 303 Sweden 2,563 300 Israel 2,244 322 Norway 2,018 304 Total 46,394 4,839 Denmark 2,169 303 Country Country The Data Prevalence Pain - A Widespread Problem Strikes almost one in five adults across Europe = 19% (75 million people) - Prevalence highest in Norway, Poland and Italy (>one in four) - Prevalence lowest in Spain, but still more than one in ten (11%) One-third of all European households are affected by chronic pain Prevalence of Chronic Pain by Country – Based on Complete Screener Data – Overall Prevalence = (n=46,394) Moderate Poland (n=3,812) Italy (n=3,849) Belgium (n=2,451) Austria (n=2,004) 9% 21% Norway (n=2,018) 8% 19% 13% 13% 19% Severe 6% 30% Germany (n=3,832) 27% Israel (n=2,244) 5% 12% 7% 17% 10% 17% 13% 26% Denmark (n=2,169) 10% 6% 16% 8% 23% Switzerland (n=2,083) 10% 6% 16% 4% 21% France (n=3,846) 10% 5% 15% 15% 17% Finland (n=2,004) 12% 7% 19% Ireland (n=2,722) 9% 4% 13% Sweden (n=2,563) 13% 5% 18% UK (n=3,800) 8% 5% 13% Netherlands (n=3,197) 14% 4% 18% 0% Spain (n=3,801) 5% 50% Moderate Severe 0% 6% 11% 50% Patients Forced to Live in Pain On average, sufferers live with chronic pain for 7 years A fifth suffer with pain for more than 20 years % Duration of Pain Reported by Chronic Pain Sufferers (n=4,839) 25 22 21 20 20 17 15 10 5 8 8 4 0 6 Months to <1 Year 1 to <2 2 to <5 5 to <10 10 to <15 15 to <20 20 Years Years Years Years Years Years or More Source: SQ6. For how long have you suffered from pain due to your illness or medical condition? How Often Does it Hurt? One third of sufferers report experiencing chronic pain all the time Frequency (n=4,839) 34% At All Times 35% 31% Daily Several Times a Week Source: SQ8. How often do you experience pain? (Read list) SQ7. When was the last time you experienced pain? (Read list) Nature of Chronic Pain Where does it hurt? The most frequent cause of chronic pain is arthritis / osteoarthritis (34%) The most common location is the lower back Most Common Causes of Pain Reported by Chronic Pain Sufferers (n=4,292) 34 Arthritis/osteoarthritis 15 Herniated/deteriorating discs 12 Traumatic injury 8 Rheumatoid arthritis 7 Migraine headaches 6 Fracture/deterioration of spine Nerve Damage 4 Cartilage Damage 4 Whiplash 4 3 Surgery 0 % 5 10 15 20 25 30 35 40 Source: SQ11. Where is your pain located? SQ12. Please tell me the illness or medical condition that is the cause of your pain. Q1. Is your pain caused by…? And How Much? One third reported that their pain was so severe they could not tolerate any more Tolerance Level for More Pain (n=4,785) My pain was so severe, I could not tolerate any more I could tolerate a little more pain 31% 47% 18% 4% I could tolerate somewhat more pain I could tolerate a lot more pain 0% 100% Source: Q4. Thinking about the intensity of your pain when it was at its worst, which of the following statements best describes your tolerance level of this pain? Quality of Life Chronic Pain is Insidious Over 40% of sufferers report feelings of helplessness or inability to think or function normally One in six say the pain is sometimes so bad they want to die Chronic Pain is Insidious So me days the pain is so bad, I want to die I am in to o much pain to take care o f myself and o ther peo ple I feel alo ne with my pain I feel much o lder than I really am I canno t remember what it feels like no t to be in pain I canno t functio n no rmally M y pain keeps me fro m thinking o r co ncentrating clearly B eing in pain makes me feel helpless I feel tired all the time M y pain is just part o f my medical co nditio n % 0 10 20 30 40 50 60 70 80 90 * Higher=Agree more strongly with the statement Source: Q37. Now we would like to understand how pain affects your life. I am going to read a list of statements that could be used to describe how people who are experiencing pain think and feel about it. For each statement I read, please think about yourself and your own pain and tell me how much you agree or disagree with each statement using a 5-point scale where 1=Disagree Completely, 2=Disagree Somewhat, 3=Neither Agree nor Disagree, 4=Agree Somewhat, and 5=Agree Completely. (Read list) And Can Devastate Lives Chronic pain has an undoubted impact on the daily lives of sufferers Chronic pain impacts on daily activities such as lifting, exercising, sleeping and working outside One quarter (26%) feel that their pain impacts employment 15 working days a year are lost to pain (estimate on 6 month data) One in five reports - losing a job (19%) - or have been diagnosed with depression And Can Devastate Lives Weighted Total UK (n=243) France (n=232) Germany (n=232) Italy (n=233) Spain (n=255) Poland (n=220) Sweden (n=292) Norway (n=289) Denmark (n=298) Lost job 19% 25% 15% 14% 17% 22% 14% 24% 24% 29% Changed job responsibilities 16% 16% 12% 11% 28% 8% 19% 28% 28% 21% Changed jobs entirely 13% 18% 12% 8% 20% 4% 13% 25% 22% 11% Been diagnosed with depression 21% 24% 18% 20% 22% 29% 14% 24% 28% 11% Source: Q6a. Have any of the following ever happened as a result of your pain…? (Read list) Q6b. Have you ever been diagnosed with depression by a medical doctor as a result of your pain? And Can Devastate Lives Netherlands (n=294) Belgium (n=286) Finland (n=290) Ireland (n=272) Switzerland (n=274) Austria (n=279) Israel (n=299) Lost job 29% 15% 22% 15% 16% 20% 25% Changed job responsibilitie s 20% 9% 19% 24% 15% 20% 17% Changed jobs entirely 16% 9% 14% 23% 12% 11% 14% Been diagnosed with depression 19% 19% 22% 19% 18% 21% 16% Doctors and Patient Relationships Revealed Patients See Different Clinicians But Rarely Pain Specialists Consultations were most frequently with GPs Orthopaedists and to a lesser degree Rheumatologists and Neurologists are also seen Only 23% report seeing an actual pain specialist Chronic Pain Patients See Many Different Clinicians Physician Specialty % Who See General/Family Practitioner 70% Orthopaedist/Orthopaedic Surgeon 27% Rheumatologist Neurologist//Neurosurgeon 9% 10% Internist 7% Physiotherapist 6% General Surgeon 3% Pain Management Specialist 2% Osteopath 2% Other * 20% When asked specifically whether ever been to a pain management specialist 23% * Other includes Alternative Medicine/Homeopathy, Anesthaesiologist/Anesthaetist, Cardiologist, Chiropractor, Ear Nose Throat, Gastroenterologist, Gynecologist, Hematologist, Infectious Disease, Oncologist, Ophthalmologist, Physical Medicine, Plastic Surgeon, Psychiatrist, Pulmonoloigst, Radiologist, Sports Medicine, and Urologist. Source: Q12c. What kinds of doctors are you currently seeing specifically for your pain? Q12d. Have you ever been to see a pain management specialist? Doctors Defended The majority (62%) are very or extremely satisfied with the doctor who treats their pain have seen them 1.3 times in last six months % 40 36 35 28 30 26 25 20 15 10 7 5 3 0 Extremely Satisfied Very Satisfied Somewhat Satisfied Not Very Satisfied Not at All Satisfied * Higher = better Source: Q14d. How satisfied are you with the doctor who currently treats your pain? (Read list) Q14e. Why do you say you are not very/not at all satisfied with the doctor who currently treats your pain? But There are Still Problems Some patients worry about their doctor’s willingness and commitment to treating their pain A sizeable proportion (43%) of chronic pain sufferers believe that their physicians are more focused on their illness than their pain In making a diagnosis or deciding on treatment, few doctors use pain rating scales (10%) Most discussions are patient initiated But There are Still Problems 71 I tell him/her 52 Doctor examines me Doctor asks me to move the part of my body that is in pain 15 11 Doctor asks me to walk Doctor uses a pain scale 2 Doctor does nothing 2 1 Other % 0 10 20 30 40 50 60 70 80 Source: Q37. disagree with each statement using a 5-point scale where 1=Disagree Completely, 2=Disagree Somewhat, 3=Neither Agree nor Disagree, 4=Agree Somewhat, and 5=Agree Completely. (Read list) Source: Q13c. How does the doctor who generally treats your pain determine how much pain you are in? Q14a. Has any doctor or medical professional ever scored you on a pain scale? Feelings about Treatments Two thirds of sufferers are always willing to try new treatments But almost as many are worried about potential side effects of pain medication Feelings about Treatments I am taking so many medicines, I don't want to take pain medicine too M y pain is not severe enough to take pain medicine I am afraid of being addicted to pain medicine I would spend all my money on pain treatment if I knew it would work I would rather take medication for my illness than my pain I worry about the side effects of pain medicine I am always willing to try a new treatment for pain 0 10 20 30 40 50 60 70 % * Higher=Agree more strongly with the statement Source: Q37. Now we would like to understand how pain affects your life. I am going to read a list of statements that could be used to describe how people who are experiencing pain think and feel about it. For each statement I read, please think about yourself and your own pain and tell me how much you agree or disagree with each statement using a 5-point scale where 1=Disagree Completely, 2=Disagree Somewhat, 3=Neither Agree nor Disagree, 4=Agree Somewhat, and 5=Agree Completely. (Read list) Use of Prescription Medicines Pain sufferers are proactive with 69% of chronic pain sufferers treating their pain in some way, mainly via prescription medications Over one in four (26%) have tried then stopped taking prescription pain medication Use of Prescription Medicines Chronic Pain Sufferers Reporting Currently Treating Their Pain in Any Way (n=4,827) Use of Prescription Medications To Treat Chronic Pain (n=4,839) 26% 31% 53% 69% Not Treating 21% Treating Lapsed Never Taken Currently Taking Source: Q11a. Is your pain currently being treated in any way? Q15a. Have you ever taken prescription medicine for your pain? Q16a. Are you currently taking prescription pain medicine? Use of Prescription Medicines NSAIDs (44%) are most used class of pain medication Other commonly prescribed drugs are weak opioids (23%) and paracetamol (18%) Mean number of pills taken everyday is 3.4 Use of Prescription Medicines 50 % 45 Weak Opioids 40 35 44 30 Strong Opioids 25 18 20 23 15 10 6 5 3 5 3 3 2 Triptan Anti-Epileptic 0 NSAID Narcotic Analgesic Paracetamol COX-2 Inhibitor Barbiturate Ergotamine Tricyclic/ SSRI/SNRI Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing? Classes of Prescription Pain Medications Chronic Pain Sufferers Report Currently Using for Pain – European Summary – (n=2,063) 50% 44% 23% 18% 6% 5% 3% 3% 3% 2% 2% 1% 1% 0% N SA ID W k ea O d oi i p ol m ta e c ra 2 a XP O C r to i b hi n I d oi i p O e in am t o g SR g n S / Er ro t ic e l S t yc ra c u i t Tr bi r a B N I/S RI an t ip Tr D M AR D / id o er t S A i-E t n tic p le pi M c us le an x la Re B Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing? t C a/ t e C B ke c lo r Weighted Total UK (n=300) France (n=300) Germany (n=302) Italy (n=300) Spain (n=301) Poland (n=300) Sweden (n=300) Norway (n=304) Denmark (n=303) NSAIDs 44% 23% 25% 54% 68% 49% 71% 27% 24% 38% Weak Opioids 23% 50% 19% 20% 9% 13% 28% 36% 50% 8% Paracetamol 18% 38% 38% 2% 6% 8% 8% 26% 45% 0% COX-2 Inhibitors 6% 3% 6% 8% 7% 2% 1% 7% 11% 8% Strong Opioids 5% 12% 4% 4% 0% 1% 4% 3% 6% 11% Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing? (most common mentions) Netherland s (n=300) Belgium (n=301) Finland (n=303) Ireland (n=300) Switzerland (n=300) Austria (n=303) Israel (n=322) NSAIDs 36% 42% 54% 32% 48% 58% 53% Weak Opioids 14% 15% 22% 19% 18% 14% 5% Paracetamol 11% 33% 26% 5% 12% 4% 3% COX-2 Inhibitors 16% 13% 16% 8% 13% 4% 36% Strong Opioids 5% 7% 2% 13% 2% 5% 5% Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing? (most common mentions) Use of Non- Prescription Medicines Non-Prescription (OTC) Classes and Medications Chronic Pain Sufferers Report Currently Using for Pain (n=1,914) 100% 55% 43% 13% 0% NSAID Paracetamol Weak Opioid Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing? Alternative Therapies 35 31 % 30 30 25 21 20 15 13 10 10 9 8 5 3 3 3 Cold Herbal supps 4 Diet/special foods 5 2 0 Therapy Relaxation therapy Nerve stimulation Exercise Heat Ointment/creams Acupuncture Physical therapy Massage None Source: Q28. What other methods, remedies or treatments, apart from medications have you ever tried to relieve your pain for the medical condition or illness we have been discussing? How Patients Rate Treatments The majority (64%) of pain sufferers feel their treatment is inadequate at times Chronic pain sufferers report that there is considerable room for improvement in the effectiveness of pain treatments How Patients Rate Treatments Pain from Activity (n=4,787) Adequacy of Pain Control from Medication (n=2,450) 21% 36% 64% 79% Experience Pain from Activity Pain Medication Inadequate at Times Do Not Experience Pain from Activity Pain Medication is Adequate Source: Q21. Do you ever experience an increase in pain during the day as a direct result of an activity you did? Q20. Are there ever times when your pain medicines are not adequate to control your pain? Learning About New Pain Treatments Over one quarter of all chronic pain sufferers feel they never hear about new methods of treating pain Majority rely on newspapers, TV and magazines Just 5% surf the ‘Net for new options Source: Q36. Where do you hear about new methods for treating pain? Learning About New Pain Treatments Where Chronic Pain Sufferers Report Hearing About New Pain Treatments (n=4,586) % 45 40 39 35 33 30 27 24 25 20 14 15 10 5 4 Internet Pharmacy 5 0 Magazines/ Newspapers Television Doctor's Office Friends, Family, Coworkers Do Not Hear About New Methods Source: Q36. Where do you hear about new methods for treating pain? The Largest Pain Survey in the World