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Chronic Pain: Hope Through Research

The Terrible Triad

September, 1997

Pain of such proportions overwhelms all other symptoms and becomes the problem. People so afflicted often cannot work. Their appetite falls off. Physical activity of any kind is exhausting and may aggravate the pain. Soon the person becomes the victim of a vicious circle in which total preoccupation with pain leads to irritability and depression. The sufferer can't sleep at night and the next day's weariness compounds the problem -- leading to more irritability, depression, and pain. Specialists call that unhappy state the "terrible triad" of suffering, sleeplessness, and sadness, a calamity that is as hard on the family as it is on the victim. The urge to do something -- anything -- to stop the pain makes some patients drug dependent, drives others to undergo repeated operations or worse, resort to questionable practitioners who promise quick and permanent "cures."

"Chronic pain is the most costly health problem in America,"
says one of the world's authorities on pain. He and others estimate annual costs, including direct medical expenses, lost income, lost productivity, compensation payments and legal charges, at close to $50 billion. Here's how that adds up:

  • Headache. At least 40 million Americans suffer chronic recurrent headaches and spend $4 billion a year on medications. Migraine sufferers alone account for 65 million workdays lost annually.
  • Low back pain. Fifteen percent of the adult U.S. population have had persistent low back pain at some time in their lives. Five million Americans are partially disabled by back problems, and another 2 million are so severely disabled they cannot work. Low back pain accounts for 93 million workdays lost every year and costs over $5 billion in health care.
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  • Cancer pain. The majority of patients in intermediate or advanced stages of cancer suffer moderate to severe pain. More than 800,000 new cases of cancer are diagnosed each year in the U.S., and some 430,000 people die.
  • Arthritis pain. The great crippler affects 20 million Americans and costs over $4 billion in lost income, productivity and health care.

Other pain disorders like the neuralgias and neuropathies that affect nerves throughout the body, pain due to damage to the central nervous system (the brain and spinal cord), as well as pain where no physical cause can be found -- psychogenic pain -- swell the total to that $50 billion figure.

Many chronic pain conditions affect older adults. Arthritis, cancer, angina -- the chest-binding, breath-catching spasms of pain associated with coronary artery disease -- commonly take their greatest toll among the middle-aged and elderly. Tic douloureux (trigeminal neuralgia) is a recurrent, stabbing facial pain that is rare among young adults. But ask any resident of housing for retired persons if there are any tic sufferers around and you are sure to hear of cases. So the fact that Americans are living longer contributes to a widespread and growing concern about pain.

Neuroscientists share that concern. At a time when people are living longer and painful conditions abound, the scientists who study the brain have made landmark discoveries that are leading to a better understanding of pain and more effective treatments.

In the forefront of pain research are scientists supported by the National Institute of Neurological Disorders and Stroke (NINDS), the leading Federal agency supporting research on pain. Other Federal agencies important in pain research include the National Institute of Mental Health (NIMH), the National Institute of Dental Research (NIDR) and the National Cancer Institute (NCI). Within the last decade both the International Association for the Study of Pain and the American Pain Society have been established and grown into flourishing professional organizations attracting young as well as established research investigators and practicing physicians.

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This article was provided by U.S. National Institutes of Health. Visit NIH's website to find out more about their activities, publications and services.