Everyone who knows a person with chronic pain is aware that it comes with a huge price on quality of life, but indeed chronic pain also have a heavy economic price for the society in general. A price we might be able to reduce by awareness and intervention for those who need it and especially for those who need it most.

The size of the economic burden is of cause different from country to country, based on differences in health economy and in the organisation and extent of health care and social care. But all presented figures from different countries are high and in it self calls for action.

Recently a Swedish study was published looking at “Diagnosis Related To Pain” (DRTP), that is not for chronic pain alone but total costs for persons with diagnosis connected with chronic pain conditions. The total cost for society was a huge 20% of Swedish tax burden. Indirect costs associated with lost production because the patient is absent from work constituted the largest proportion of the cost estimate (about 60%).

If we hold this in mind when looking at another recent published study looking at the economic burden associated with chronic pain, there is important information to get. In this study from Ireland the researches found, that a small proportion of patients account for the bulk of costs—the top 5% most expensive patients accounted for 26% of costs, the 10% most expensive patients were responsible for 43% of all costs, and the top 20% of patients accounted for 64% of all costs.

Now who are those patients with the highest costs? Well, the Irish researchers found two important determinants of costs one is the intensity of experienced pain, high levels of experienced pain was four times higher than for the group with low level of pain. The other factor was patients with depression, as the authors pointed out, this is unsurprising, but highlights the importance of intervention also from an economic perspective.

You would probably also guess, that higher pain scores are connected to higher economic costs, but these two papers make it clear and provide the evidence as well as documents the surprisingly high costs and their distribution among the patients.

While we often are still looking for the biomedical solution for the pain, encouraged by the patient experiencing that “something must be wrong”, there is a great risk of missing the co-existing depression, and miss the opportunity to reduce the risk of developing chronic pain, by early sufficient pain treatment – and that is more than pharmaceuticals.

We must screen for depression and pay attention to the experienced pain intensity, because we need to reduce both the human and the economical cost of chronic pain, one of the major health and health care problems of our time.

Kim Kristiansen is a family physician in Denmark who blogs at Picture of Pain.

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