How Do People In Pain Seek Relief?

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by Teri Robert, PhD

We see discussions about pain relief in many places – on television, in magazines, online. We’re inundated with advertising for various forms of pain relief from over-the-counter medications, to prescription pain relievers, to complementary therapies. Some claims are valid; others are questionable.

A group of researchers at the University of Texas undertook a study to determine how people in pain seek relief. The results were enlightening, validating the feeling among many pain patients that pain is often not adequately treated and controlled,

“Difficulty communicating with health professionals and lack of health insurance contributed to inadequate pain relief. Almost all people with pain used multiple methods to control their pain.” 1

An article in The Journal of Pain reports the findings of this study, with the authors asking several pertinent questions:

“Pain is one of the most frequent reasons that people seek medical care, yet we have little information about how successful this medical care is and what characterizes those who seek it. Is there a threshold of pain severity or its impact that drives people to seek medical care? In addition, seeking medical care is but one of many strategies that people use to cope with pain. How successful are alternative strategies such as prayer or home remedies perceived to be, and how often are they used?” 1

Study methods:

Data for 1,204 respondents was drawn from a nationwide survey conducted by ABC News, USA Today, and Stanford University Medical Center who participated in a computer-assisted telephone interview.

• Survey questions addressed: type of pain, severity of pain at its worst and on average, primary location and source of pain, and impact of pain on daily life and activities.
  
  
• Relevant to patients’ most recent experience with pain, they were asked to rate their worst pain as mild, moderate, severe, or very severe.
  
  
• Using the Brief Pain Inventory (BPI), rated six items on a scale of 1 to 4, and he authors treated the mean score of those 6 items as the degree of pain-induced interference with functioning: how much pain interfered with mood, day-to-day activity, enjoyment of life, relationships with others, ability to do work, sleep.
  
  
• Respondents were asked if they had if they had talked to a doctor about their pain and if so, how well the doctor seemed to understand their pain and how much pain relief they got from seeing their doctor.
  
  
• The survey asked which of a list of 12 alternative or additional methods participants had tried for pain relief: over-the-counter drugs, home remedies (such as a heating, cooling, etc.), bed rest, prayer, massage therapy, homeopathic or herbal remedies, acupuncture, chiropractic treatment, meditation, yoga, alcohol, and marijuana. If participants had tried alternative or additional methods, they were asked to rate how well those methods had worked.

Study results:
Of the 1,204 study participants, 31% were found to have had recent pain.

Among study participants reporting recent pain:

• 75% of participants reporting recent pain sought medical attention for pain relief.
  
  
• Those most likely to seek medical attention were adults who had recurrent or chronic pain, who reported severe pain, who were older, or who reported greater pain-related interference with activities.
  
  
• Only 56% of those who sought medical attention achieved good pain relief.
  
  
• Perceived communication difficulties and being without health insurance were obstacles to obtaining pain relief from consulting a doctor.
  
  
• Besides seeking medical attention, 92% of respondents with recent pain tried 3 or more other pain relief methods.
  
  
• Alternative pain relief methods were not reported to be as effective as medical attention for respondents who tried those methods along with medical attention.
  
  
• However, for respondents who did not seek medical attention, more than half of those who tried prayer or going to a chiropractor associated these methods with pain relief.

Study conclusions:
“Our analysis showed that at any given time, one third of Americans are bothered by recent moderate to severe pain that limits their normal function. Almost all of our study subjects had tried alternative methods for pain relief, and more than 90% had tried 3 or more methods. Although three-fourths sought treatment from the medical care system, only half of those who sought medical attention reported good pain relief. Communication difficulties between patient and health care provider and lack of health insurance were major factors associated with getting less pain relief. For those who did not seek medical attention, alternative pain relief strategies were used for pain control, with varying levels of success.” 1

Summary and comments:
From this study we see that 75% of Americans experiencing pain seek medical care, but only 56% of them achieve good pain relief. The vast majority of people in pain, 92%, try complementary methods of pain relief, which in this case included over-the-counter medications.

Although it’s consistent with human nature not to take action until activities are curtailed, whenever possible, Americans need to be encouraged to see pain relief before it becomes severe or chronic. Earlier intervention could result in better management of pain long-term, better overall health, and improved quality of life.

At a time when animals are being cloned, stem cell research is progressing, and some cancers can be cured, it’s a bit startling to realize that only 56% of people who seek medical care for pain find adequate relief. Although not mentioned directly in this study, a lack of trained pain management specialists may be a part of this issue, and DEA scrutiny of physicians’ prescribing of pain medications may be adding to the lack of doctors practicing in the field.

Other studies have shown the value of doctors having good communication skills. Tamblyn et al concluded, “We found that communication and clinical decision-making ability were important predictors of future complaints to regulatory authorities,” and recommended standardized assessment of communication skills before physicians enter into practice. 2 The communication burden, however does not fall only on the physician. Patients need to be educated about pain and be proactive as treatment partners in their care. Studies have also shown that educated patients are more compliant with treatment plans and have better outcomes. 3, 4, 5

Better communication and more patient education would help address the needs of Americans in pain. That would not, however, resolve the problem of lack of health insurance. None of these is a new issue. Now that we’ve looked at how people in pain seek relief, we need to find ways to remedy the issues that prevent so many people from seeking appropriate care for pain.

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Resources:

1. Shi, Quiling; Langer, Gary; Cohen, Jon; Cleeland, Charles S. “People in Pain: How Do They Seek Relief.” The Journal of Pain, Vol 8, No 8 (August), 2007: pp 624-636.
   
   
2. Tamblyn, Robyn; Abrahamowicz, Michal; Dauphinee, Dale; Wenghofer, Elizabeth; Jacques, André; Klass, Daniel; Smee, Sydney; Blackmore, David; Winslade, Nancy; Girard, Nadyne; Du Berger, Roxane; Bartman, Ilona; Buckeridge, David L.; Hanley, James A. “Physician Scores on a National Clinical Skills Examination as Predictors of Complaints to Medical Regulatory Authorities.” JAMA. 2007;298:993-1001.
   
   
3. Rothrock, John Farr, Parada, Victoria A., Sims, Cheryl, Key, Kristin, Walters, Naomi S. & Zweifler, Richard M. (2006) "The Impact of Intensive Patient Education on Clinical Outcome in a Clinic-Based Migraine Population." Headache: The Journal of Head and Face Pain 46 (5), 726-731. doi: 10.1111/j.1526-4610.2006.00428.
   
   
4. Helliwell, P.S.; O’Hara, M.; Holdsworth, J.; Desselden, A.; King, T.; Evans P. “A 12-Month randomized controlled trial ofpatient education on readiographic changes and quality of life in early rheumatoid arthritis.” Rheumatology 1999;38:303-308.
   
   
5. Galefoss, Frode. “The effects of patient education in COPD in a 1-year follow-up randomized, controlled trial.” Patient Education and Counseling. Volume 52, Issue 3, March 2004, Pages 259-266. doi:10.1016/S0738-3991(03)00100-9 

© Teri Robert, 2007
Last updated November 9, 2007.