Impact of pain on quality of life

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Estimates of the economic burden associated with pain fail to do justice to the extent of suffering and reduced quality of life experienced by patients and warrants pain relief being regarded as a universal human right.18 Chronic pain, along with musculoskeletal disorders, has been shown to be associated with some of the poorest quality-of-life states.60,61,62,63 In patients referred to a Danish multidisciplinary pain center, the severity of impairment was equal to or lower than patients with cardiopulmonary diseases and major depression, and their Psychological General Well-being Scale scores were lower than those with hypertension and gastrointestinal problems, while they also displayed high levels of anxiety and depression, as measured by the Hospital Anxiety and Depression Scale.63 In a study of over 600 patients attending a chronic pain clinic in Sydney, Australia, there were greatly reduced SF-36 domain scores between clinic patients and Australian norm values, as shown in Table 6.1.61 Relatively low SF-12 scores were demonstrated in a European study on chronic musculoskeletal pain, which also highlighted that up to 57 percent of respondents were in constant pain and up to 22 percent were in daily

pain.

Focusing on the burden and impact of chronic pain, and allocating additional resources to deal with the problem, does not necessarily result in a more efficient, or indeed equitable, allocation of resources. In order to

Table 6.1 SF-36 scores in pain clinic attendees compared with norms.

SF-36 domain

Pain clinic

Australian norm

General health

4B.S

71.S

Physical functioning

37.1

B2.S

Role physical

12.7

79.9

Bodily pain

3S.1

7S.B

Vitality

40.7

S4.S

Social functioning

41.4

BS.0

Emotional health

3S.9

B2.9

Mental health

S3.S

7S.9

Source: Data reprinted with permission from Ref. 61.

Source: Data reprinted with permission from Ref. 61.

move in such a direction it is necessary to employ the techniques of economic evaluation.

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