North-South divide in chronic pain
(12 September 2018)
England has a North-South ‘pain divide’, with a clear geographical split in the prevalence and intensity of chronic pain and the use of potentially addictive opioid pain killers, shows new research.
The study involving researchers from Durham University is published in the online journal BMJ Open.
The team behind the research warns that better guidance for clinicians to manage chronic pain is essential if an ‘opioid epidemic’ similar to the one in the US is to be avoided.
There are public health concerns associated with the long term use of pain relievers or opioids and doubts about their ability to effectively treat chronic pain, say the researchers.
Prescription pain killers
Some 23 million prescriptions for opioid painkillers were written in the UK in 2014 at a cost of around £322 million. Misuse is becoming a significant public health issue, including in the US, where the death rate from opioid misuse has quadrupled over the past 15 years.
But it’s not clear whether the rise in opioid use is being driven by need or inappropriate prescribing. To try and find out, the researchers drew on the responses of 5711 people to the national Health Survey for England for 2011.
The survey included questions on chronic pain, defined as lasting three or more months, its intensity, its impact on routine activities of daily living, and whether opioids had been prescribed to treat it.
The prevalence of chronic pain was higher in the North than it was in the South*: just under 37 percent compared with 35 percent. Across the nine regions, the highest prevalence was in the North East (43%), and the lowest in London (29%).
Pain intensity was greater in the North, where nearly 12.5 percent of respondents said their pain was moderately or severely limiting, compared with just over 9 percent of Southerners.
Levels of anxiety and poor general health were also higher in the North than in the South.
But despite similar levels of chronic pain in the North and the South, opioid use was higher in the North: 2.5 percent vs 1.7 percent.
Dr Paul Chazot is Associate Professor of Pharmacology & Pain Special Interest group leader in the Wolfson Research Institute for Health and Wellbeing at Durham University was involved in the research. He said: “As our research shows that the link between pain and use of opioid painkillers is significant in the North East of England in particular, we are now looking at how chronic pain can be managed better and more effectively in our region without reliance on analgesic drugs.”
And while the use of opioids was associated with the intensity of chronic pain, after taking account of potentially influential factors, such as anxiety levels, it was also linked to educational attainment and household income.
Households in the higher income brackets were significantly more likely to use opioids than those in the lowest, as were those where respondents had reported ‘bad’ or ‘very bad’ general health compared with those who said their health was ‘very good.’
The study was conducted by researchers from Newcastle University, FUSE, Canterbury Christchurch University, The James Cook University Hospital and the Wolfson Research Institute for Health and Wellbeing at Durham University.
*The North East, North West, and Yorkshire and the Humber regions denoted the North of England, while London, East of England, West Midlands, East Midlands, South East, and South West regions denoted the South.