The Price Tag of Chronic Pain

Question: An 80-year-old with arthritis, a 50-year-old with a bad back, and a 20-year-old with migraines -- what do these people have in common?

Answer? Chronic pain. Pain was once viewed only as a symptom, the consequence of another condition. It was often ignored as doctors focused on treating its underlying medical cause.

But for almost everyone, pain is what matters. "It's pain that brings people into the doctor's office," says Penney Cowan, executive director of the American Chronic Pain Association. "It's pain that they want treated."

Pain has emerged as a devastating public health problem. According to the American Chronic Pain Association, pain is the No. 1 cause of adult disability in the U.S. At least one out of six people live with chronic pain.

Putting a Dollar Sign on Debilitating Pain

Yet estimates for the economic impact of pain vary. A 2003 study published in The Journal of the American Medical Association put the cost at $61.2 billion per year. But that's only the money drained from U.S. businesses because of productivity lost from employees in pain. It only included arthritis, back pain, headache, and other musculoskeletal pain; other kinds of chronic pain were excluded.

And while looking at pain's bottom line is important, no price can be put on the enormous suffering it causes.

"The costs are incalculable," says Christopher L. Edwards, PhD, assistant professor of psychiatry at Duke University School of Medicine. "How do you estimate the value of lost self-worth? How do you estimate the loss of family, friends, and a sense of accomplishment?"

What is causing all of this pain -- and cost? For the most part, it's the usual suspects:

• Back pain
• Neck pain
• Headaches
• Surgery
• Diabetes
• Cancer
• Joint pain
• Other conditions

And studies show the incidence of pain seems about the same among age groups. What changes is the type of pain.

For example, people in their 20s and 30s are more likely to suffer from debilitating headaches. The incidence of back pain peaks in middle age. The elderly often face arthritis and other painful conditions, like shingles. What unites these groups is the pain itself -- and the hidden costs that can change lives.

A Hidden Cost of Chronic Pain: Worsening Health

That's because pain can start a vicious cycle that has a direct impact on your health.

Perhaps your knee starts hurting when you walk. The natural response for many is to walk less. But "if you stop walking, the muscles, tendons and nerves in your legs atrophy and deteriorate," says Edwards. "If you become inactive as a result, that leads to all sorts of problems like heart disease and diabetes."

Just one injury can turn an active, healthy person into an inactive and unhealthy one.

Surgery can have the same result. "Many people develop pain after surgery or after illnesses like shingles," says Steven P. Cohen, MD, an anesthesiologist in the division of pain medicine at Johns Hopkins School of Medicine. If they don't get the pain treated promptly, he says, it can become chronic. And that can lead to yet greater ills.

"People who have chronic pain are exponentially more likely to have psychiatric illnesses like depression and anxiety disorders," says Edwards.