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Prevalence_and_treatment_of_chronic_pain_in_the_Phils.pdf
Abstract
Background: There are currently no data on the
prevalence and incidence of chronic pain in the
Philippines.
Objective: This study was undertaken to determine
the incidence and prevalence of chronic pain in
the general adult population of the Philippines. It
also aimed to establish the demographic profile
of chronic pain sufferers, identify the causes and
intensity of chronic pain, and understand the
impact of chronic pain on daily living and quality
of life. This study also explored current treatment
practices for patients with chronic pain, their
levels of satisfaction with treatment, and barriers
to obtaining appropriate treatment.
Methodology: The study was conducted in the
Philippines via a quantitative sample survey that
involved face-to-face interviews using a two-phase
structured questionnaire.
pain
M+S
was
more
commonly
reported
by
women
and
the
elderly.
The
most
common
locations of pain were the knees, back and lower
back. Daily routine was affected in about half
of the sufferers, but they had rational attitudes
to pain and positive views of medical treatment.
High consultation fees discouraged nearly twothirds of sufferers from seeking medical advice
for their pain. Despite the availability of effective
pain treatments, a large proportion of patients
taking prescription painkillers reported that the
medication was less than effective, indicating a
large gap between achievable pain relief targets
and patients expectations of pain medications.
Conclusion: The Philippines has a relatively high
prevalence of chronic pain M+S. There is a need
for improved pain management to ensure that
patients with chronic pain receive appropriate
and effective treatment.
Keywords:
prevalence,
treatment.
I ntroduction
The International Association for the Study of
Pain (IASP) defines pain as an unpleasant sensory
and emotional experience arising from actual or
potential tissue damage or described in terms of
such damage. Chronic pain, especially of the
moderate-to-severe
type,
diminishes
a
persons
quality of life, causes loss of work productivity, 1,2
and may be associated with anxiety or depressive
disorder. 3
Chronic pain of moderate-to-severe intensity
affects many people, but epidemiological studies
have been limited to Western countries and a
few Asian countries. 49 A World Health Organization
(WHO) study assessing the prevalence and impact
*Head, Pain Control Clinic, Makati Medical Center; Head, Pain
Management Center, St. Lukes Medical Center, Global City
**Director, Pain Management Center, Quezon City
Asia,
chronic
pain,
quantitative survey, the
incidence,
Philippines,
61
Lu H, et al
M aterials
and Methods
Questionnaire
Using
a
two-part
structured
questionnaire,
a
quantitative
sample
survey
was
conducted
in
urban
and
rural
areas
of
the
Philippines.
The questionnaire, previously used to study the
prevalence
of
chronic
pain
in
16
European
countries and in Japan, 4,7 had been validated for
use in the Philippines.
Screening and detailed interviews
Face-to-face
interviews
were
carried
out
between February and March 2006 among adults
aged 1885 years. Listing interviews were conducted
to screen the respondents and to estimate the
prevalence and incidence of chronic pain in the
sample population. In this study, incidence was
defined as the annual rate of new cases or those
suffering from chronic pain in the last one year.
Respondents were considered to be suffering
from
chronic
pain
if:
(1)
they
had
suffered
from pain in the last six months; (2) they had
pain for more than three months; (3) they had
experienced pain in the last month; (4) they
had pain frequency of several times a week or
more (chronic pain sufferers); and (5) their pain
measured four or more on the 10-point pain
scale
(moderate-to-severe
chronic
pain
sufferers
[chronic pain M+S]). Respondents who fulfilled these
criteria were interviewed further, using a detailed
questionnaire.
The
detailed
questionnaire
was
designed to assess current attitudes, beliefs and
practices with respect to pain.
O bjective
This study was undertaken to determine the
incidence and prevalence of chronic pain in the
general adult population of the Philippines. It
also aimed to establish the demographic profile
of chronic pain sufferers, identify the causes and
intensity of chronic pain, and understand the
impact of chronic pain on daily living and quality
of life. This study also explored current treatment
practices for patients with chronic pain, their
levels of satisfaction with treatment, and barriers
to obtaining appropriate treatment.
Sampling
To ensure proper representation of the overall
adult population, multi-stage, stratification random
sampling was conducted across five regions of
the Philippines, namely Greater Manila, north and
central Luzon, south Luzon, Visayas, and Mindanao.
The Kish grid was used to select members within
62
Listing
Detailed
Rural
Listing
Detailed
Total
Listing
Detailed
3,000
300
3,000
300
1,000
100
1,000
100
2,000
200
1,000
100
1,000
100
2,000
200
Visayas
1,000
100
1,000
100
2,000
200
Mindanao
1,000
100
1,000
100
2,000
200
Total
7,000
700
4,000
400
11,000
1,100
Lu H, et al
data were weighted by gender, age, and socioeconomic classes (SEC). SECs were classified on the
basis of home ownership, educational attainment,
occupation
of
household
head,
and
monthly
household income, such that SEC A/B (> 100,001
pesos), SEC C (30,001100,000 pesos), SEC D (7,001
30,000 pesos) and SEC E (< 7,000 pesos).
Quality control
To enhance the accuracy of representation
of the population of interest from the achieved
sample, data were weighted using the multilevel rim weighting technique. Urban and rural
35
30
25
20
15
10
5
0
Universe: (43.5)
(in millions)
All
(21.7)
(21.8)
(22.8)
(12.2)
Men
Women
18 - 35
36 - 50
(8.4)
(3.8)
(29.8)
(10.0)
(21.3)
(22.2)
50 +
ABC
Urban
Rural
Y-axis label: Categorisation of chronic pain sufferers and chronic pain sufferers (M+S)
R esults
Screening results: prevalence and incidence of
chronic pain
The total study population of 11,000 interviewed
35
30
25
20
15
10
5
0
4.6
7-15
16-24
25-36
37-48
49-60
>60
63
Lu H, et al
45
18 - 35
40
36 - 50
35
50+
30
25
20
15
10
5
0
Knee
Back
(unspecified)
Lowback
Hip
Leg
Head
Location of pain
100% 5
12
13
10 12
21
13 17
14
15
12
2210
12
14
2
3
22
11
8
20
11
11
12
16
14
16
20%
51
49
12
25
51 50
9
8
10
ra
15 14
15
Ru
36
18
18
13
en
5
-5
0
50
+
AB
C
16 15
-3
14
W
om
15
Al
15
en
5
14 19
20
19
15
13
49
40% 51 45 55 55 47 51
0%
an
60%
6
6
Ur
b
80%
5
8
More than two-thirds of chronic pain M+S
sufferers
indicated
multiple
body
locations
as
sources or causes of pain. The probability of
suffering pain from multiple locations increased with
age. Chronic pain M+S sufferers from SECs D and E
reported a higher prevalence of multiple locations.
Arthritis
was
the
most
common
cause
of
chronic pain (43%) for both men and women, and
64
When
asked
to
describe
the
pain
they
generally experienced, 81% of sufferers described
their pain as intermittent. Of the remaining 19%
who experienced constant pain,
men more than
women and people in the > 50-years age group
more than any other age group were found to be
constant pain sufferers. On a pain scale of 110,
Lu H, et al
(13% versus 7%). People with very severe pain were
mostly from the > 50-years age group (11% versus
7% and 9% from the 1835-years and 3650-years
age groups, respectively), from the SEC D and E
(21% versus 5% from the SEC ABC), and from rural
areas (11% versus 9% from urban areas).
Very few of the chronic pain M+S sufferers
reported discussing their pain with their doctors
(2%). The majority of sufferers chose to talk about
their pain with their spouses or partners (57%),
followed by other family members (39%).
33
60
50
39
31
30
26 25
25
16
20
10
40
17
21
30
22
14
12 12 12
12
9
13
12 10
se
10
0
Se
de
In
ca
20
in
6 7 4
5
xu
pe
Ex
nd
er
en
al
ci
So
ci
ce
e
iz
lif
y
jo
re
en
m
fa
of
ily
k
W
al
p
ee
Sl
in
th
ft
Li
8 8 5
7
Ta
k
Pe
rfo
rm
da
ily
ta
sk
gs
8
9
ity
48 52
tiv
40
70
62
56
ac
50 48
al
50
59
60
65
in
59
riv
61 63 62
62
60
70
36 - 50
50 +
All
Figure 5: Activities affected by chronic pain, as reported by chronic pain M+S sufferers
65
Lu H, et al
Treatment profile and practices
This study showed that treatment for pain is
prevalent in the Philippines. Only 2.7% of the
chronic pain M+S sufferers (or 0.1 million people)
had never received treatment for their pain. They
believed that they could manage the pain on their
own and did not require treatment; they generally
disliked doctors, medicines and surgery, and they
did not believe that drugs could help in relieving
their pain.
Of the 4.4 million chronic pain M+S sufferers
who had ever received treatment to manage
their pain, 80.1% reported that they were currently
receiving treatment. More women than men (80%
versus 76%), and more people in the > 50-years
age group (81%) and in the upper SEC ABC
(86%), were receiving treatment. When sufferers
currently being treated were asked to describe
the treatments they were receiving, 62% (2.1
million) admitted to self-medication only; 30%
visited their doctors and self-medicated; and 9%
only visited their doctors.
The high rate of doctors fees was reported
by 48% of chronic pain M+S sufferers currently
receiving treatment as a main reason for not
consulting a doctor for their pain. Other reasons
given were that their pain had improved (20%),
they could manage their pain on their own
(19%), they preferred alternative methods (12%),
they disliked doctors in general (8%), and they
believed that exercise helped to relieve their pain
(3%).
Consultation for pain
Of the 1.4 million chronic pain M+S sufferers
who were currently being treated and were
visiting a doctor, 69% indicated that they had
consulted with a doctor for both their illness
and pain, rather than specifically for their pain
(13%). When asked to name the type of doctor
they visited for their pain, or illness associated
with pain, 62% of the sufferers said they had
visited a general practitioner, while 38% said they
had consulted with a specialist. The majority of
sufferers who consulted with specialists belonged
to the upper SEC ABC (61%).
When asked specifically whether they had
ever heard of pain management specialists, more
than two-thirds of the chronic pain M+S sufferers
said no. Of those who were aware of pain
specialists, only 17% had actually visited one.
The average duration that sufferers consulted
with their doctors was four months (15.8 weeks).
This duration was higher among pain sufferers
in the > 50-years age group (18.2 weeks) and
in the SEC ABC (18.3 weeks), as well as among
66
Lu H, et al
60
59 57
53
60
50
50
40
30
42
32
28 30
25
30
20
19
40
29
25
29 30
28
26
18
28
25
22
19
27
24
30
17
13 14 16
17
13 14 16
10
18
10
20
12
13
20
12 9
11
1 4 2
2
0
Relieved my
pain
Shows
empathy
Keeps me
informed
Understanding
Shows me
how to
manage pain
Easy to talk
Affordable
fees
Knows my
medical
history
Good
experience
Do not give
unnecessary
medication
10
0
Tries different
treatments to
help
18 - 35
36 - 50
50 +
All
Figure 6: Factors enabling satisfaction with doctor, as reported by chronic pain M+S sufferers
100%
80%
60%
13
13
13
11
16
48 3.7 50 3.7
47 3.7
47 3.7
48
37
39
40
33
3.8
12
13
48 3.7
52
37
33
3.8
13
13
13
48 3.7
46 3.7
50
37
38
33
13
3.7
45 3.7
40%
20%
34
42
5
4
3
2
1
0%
All
Men
Women 18 - 35 36 - 50
50+
ABC
Urban Rural
Not effective
Somewhat effective
Very effective
Completely effective
67
Lu H, et al
used to relieve pain, followed by herbal medicines
and exercise. When asked about the efficacy of
the alternative therapy they were using, 46% felt
that the therapy was effective, whereas 54% felt
that it was somewhat or not effective.
D iscussion
This large nationwide quantitative survey showed
that the Philippines has an overall prevalence
of 10.4% chronic pain M+S in the general adult
population, and an annual incidence rate of 3.4%.
Women rather than men, adults in the > 50-years
age group, and those in the lower SECs are more
likely to suffer from chronic pain. This profile of
chronic pain sufferers is consistent with existing
literature exploring the relationships between pain,
gender and the ageing process. 17,18
The daily routine of almost half of the
chronic pain sufferers is affected by their pain.
Common
physical
activities
such
as
lifting,
sleeping and walking are also affected by pain.
Chronic pain has financial implications for pain
sufferers as a result of individuals taking days
off work, and loss of productivity.
This study showed that Filipinos have rational
attitudes about their pain. They believe that
their pain is due to an underlying illness, and
do not consider their pain to be a result of
past misdeeds, nor do they accept it as their
fate. The general perception of their health is
positive, and many Filipinos are receptive to
trying new treatment, and willing to pay for
it if the treatment is efficacious. Interestingly,
the proportion of the adult population who
consider themselves to be in poor health is the
same group who rate their chronic pain to be
severe.
Although
chronic
noncancer
pain
is
not
listed among the leading causes of death and
disease burden worldwide, it does increase a
patients suffering and diminishes all aspects
of quality of life. 4 As chronic pain and the
physical
and
psychosocial
complications
associated with it form a major healthcare
concern,
pain
control
is
fundamental
to
Results
from
this
managing
the
disease. 4
study showed that the majority of all of pain
sufferers have at some point been treated for
their pain, but the number of those currently
receiving
treatment
is
lower
by
20%.
Also,
nearly two-thirds of pain sufferers are opting
for self-medication with OTC and alternative
therapies rather than for medical consultation.
It is not unexpected that affordability is the
main barrier to consulting a doctor, as a large
68
S ummary
may
be
inherent
Lu H, et al
in
face-
and Conclusion
This
quantitative
survey,
the
first
large
study in the Philippines on chronic pain in
the
general
adult
population,
has
provided
important
insights
into
the
prevalence
and
incidence of chronic pain, its impact on daily
life and the attitudes of Filipinos to treatment
and
medications.
This
study
confirms
that
economics is an important factor in seeking
pain relief. The government should recognise
chronic pain as a specific health problem,
especially when the original cause of pain
has
disappeared
or
cannot
be
cured.
The
availability
and
accessibility
of
healthcare
for sufferers should be improved, as should
the
availability
and
affordability
of
pain
medications.
Healthcare
providers
and
the
pharmaceutical industry should work together
to make pain relief and management more
affordable for the general adult population in
the Philippines.
A cknowledgements
This
study
was
designed
and
funded
by
Mundipharma
Pte
Ltd.
TNS
Trend
Philippines
conducted the field survey and data processing.
Drs
Lu
and
Javier
critically
reviewed
the
manuscript and approved the final version for
submission.
The authors thank Tina V. Garcia of In Vivo
Communications (Asia) Pte Limited for medical
writing assistance.
C onflict
of Interest
Both authors have received honoraria, lecture
fees
and
travel
grants
from
pharmaceutical
companies involved in pain management, and
have declared past funding for related work. Both
doctors are members of the advisory board for
Lyrica (Pfizer), a prescription medication used to
treat neuropathic pain and fibromyalgia.
References
1. International Association for the Study of Pain: Pain
Control: the New Whys and Hows. Pain: Clinical
Updates, 1(1):1, 1993.
2. International Association for the Study of Pain:
Why Pain Control Matters in a World Full of Killer
Diseases. Pain: Clinical Updates, 12(4):1, 2004.
3. Gureje O, Von Korff M, Simon GE, Gater R. Persistent
Pain and Well-being: A World Health Organization Study
in Primary Care. JAMA, 280(2):147, 1998.
69