All posts in Shoulder Pain

How much does pain cost our society?

How much does pain cost our society?

Health economists from Johns Hopkins University writing in The Journal of Pain reported the annual cost of chronic pain is as high as $635 billion a year, which is more than the yearly costs for cancer, heart disease and diabetes.

Previous studies have not shown a comprehensive analysis of the impact on health care and labor markets associated with people with chronic pain. The Johns Hopkins researchers estimated the annual economic costs of chronic pain in the U.S. by assessing incremental costs of health care due to pain and the indirect costs of pain from lower productivity. They compared the costs of health care for persons with chronic pain with those who do not report chronic pain.

Data from the 2008 Medical Expenditure Panel Survey was used to gauge the economic burden of pain in the United States. The sample included 20,214 individuals 18 and older to represent 210.7 million U.S. adults.

The authors defined persons with pain as those who have pain that limits their ability to work, are diagnosed with joint pain or arthritis, or have a disability that limits capacity for work. To measure indirect costs, they used a model to predict health care costs if someone has any type of pain and subtracted predicted health care costs of persons who do not have pain. The impact of incremental costs of selected pain conditions were calculated for various payers of health care services.

Results showed that mean health care expenditures for adults were $4,475. Prevalence estimates for pain conditions were 10 percent for moderate pain, 11 percent for severe pain, 33 percent for joint pain, 25 percent for arthritis, and 12 percent for functional disability. Persons with moderate pain had health care expenditures $4,516 higher than someone with no pain, and individuals with severe pain had costs $3,210 higher than those with moderate pain. Similar differences were found for other pain conditions: $4,048 higher for joint pain, $5,838 for arthritis, and $9,680 for functional disabilities.

Also, adults with pain reported missing more days from work than people without pain. Pain negatively impacted three components of productivity: work days missed, number of annual hours worked and hourly wages.

Based on their analysis of the data, the authors determined that that the total cost for pain in the United States ranged from $560 to $635 billion. Total incremental costs of health care due to pain ranged from $261 to $300 billion, and the value of lost productivity ranged from $299 to $334 billion. Compared with other major disease conditions, the per-person cost of pain is lower but the total cost is higher.

The authors noted their conclusions are conservative because the analysis did not consider the costs of pain for institutionalized and non-civilian populations, for persons under 18 and for caregivers.

The Journal of Pain is published by the American Pain Society.

Journal Reference:

Darrell J. Gaskin, Patrick Richard. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13 (8): 715 DOI: 10.1016/j.jpain.2012.03.009

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Back and Neck Pain : 19 percent have persistent pain

Back and Neck Pain : 19 percent have persistent pain

A new study published in The Journal of Pain reports that 39 million people in the United States or 19 percent have persistent pain, and the incidence varies according to age and gender. The Journal of Pain is the peer-reviewed publication of the American Pain Society, www.americanpainsociety.org.

Researchers at the Washington State University College of Nursing conducted the study. They defined persistent pain as frequent or constant pain lasting longer than three months. The intent of their research was:

• Identify groups at higher risk for persistent pain

• Identify body sites, chronic conditions and disabilities associated with persistent pain

• Assess the relationship between persistent pain and anxiety, depression and fatigue

• Describe the individual experience of persistent pain.

The study was performed using data from the 2010 Quality of Life Supplement of the National Heath Interview Survey (NHIS) to calculate the prevalence of persistent pain. Results of the analysis showed that approximately 19 percent of U.S. adults reported persistent pain in 2010, and older adults were more likely to experience persistent pain than younger adults. Women also had slightly higher risk than men.

The authors noted that persistent pain correlated with other indices of health-related quality of life, such as anxiety, depression and fatigue. Individuals with those conditions were far more likely to report persistent pain.

In 2011, the Institute of Medicine reported that 100 million Americans have chronic pain. The authors explained that the disparity between the estimated pain incidence in their study and what the IOM reported is attributable almost entirely to differences in operational definitions of persistent pain.

In the 2010 NHIS, an estimated 60 percent of adults reported lower back pain in the past three months, and all of them would have been described in the IOM report as having chronic pain. However, only 42 percent of the NHIS study respondents with back pain described their pain as frequent or daily and lasting more than three months.

From a public health perspective the difference is significant. Those with persistent pain have high rates of work disability, fatigue, anxiety and depression. They also are at higher risk for long-term exposure to and dependency on pain medications.

The authors concluded that measuring pain persistence has policy implications because persistent pain is an indicator of an unmet medical need for pain management in the general population, as well as a risk factor for anxiety and depression.

Journal Reference:

Jae Kennedy, John M. Roll, Taylor Schraudner, Sean Murphy, Sterling McPherson. Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey. The Journal of Pain, 2014; 15 (10): 979 DOI: 10.1016/j.jpain.2014.05.009

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Shoulder Pain? Physiotherapy far MORE effective than Shockwave Therapy

Shoulder Pain? Physiotherapy far MORE effective than Shockwave Therapy

Supervised exercises are more effective than shockwave treatment to relieve chronic shoulder pain, finds a study published on bmj.com.

Shoulder pain is the fourth most common type of musculoskeletal pain reported to general practitioners and physiotherapists. Treatments often include physiotherapy, non-steroidal anti-inflammatory drugs, and steroid injections. Physiotherapy can include shockwave treatment, ultrasound, exercises and acupuncture.

Several studies have suggested that shockwave treatment may not be effective, but it continues to be used widely.

So a team of researchers based in Oslo, Norway compared the effectiveness of radial extracorporeal shockwave treatment (low to medium energy impulses delivered into the tissue) with supervised exercises in patients with shoulder pain.

The study involved 104 men and women aged between 18 and 70 years attending the outpatient clinic at Ullevaal University Hospital in Oslo with shoulder pain lasting at least three months.

Participants were randomised to receive either radial extracorporeal shockwave treatment (one session weekly for four to six weeks) or supervised exercises (two 45 minute sessions weekly for up to 12 weeks).

Both groups were similar at the start of the study with regard to age, education, dominant arm affected and pain duration.

All patients were monitored at six, 12 and 18 weeks and were advised not to have any additional treatment except analgesics (including anti-inflammatory drugs) during the follow-up period. Pain and disability were measured using a recognised scoring index.

After 18 weeks, 32 (64%) of patients in the exercise group achieved a reduction in shoulder pain and disability scores compared with 18 (36%) in the shockwave treatment group.

More patients in the exercise group returned to work, while more patients in the shockwave treatment group had additional treatment after 12 weeks, suggesting that they were less satisfied.

These results are in agreement with results from previous trials recommending exercise therapy and do not strengthen the evidence for extracorporeal shockwave treatment, say the authors.

They conclude: “Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain.”

Story Source:

The above post is reprinted from materials provided by BMJ-British Medical Journal. Note: Materials may be edited for content and length.

BMJ-British Medical Journal. “Exercise Better Than Shockwave Treatment For Chronic Shoulder Pain, Study Finds.” ScienceDaily. ScienceDaily, 16 September 2009.

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Calcific tendonitis: why is it soooo painful.

Calcific tendonitis: why is it soooo painful.

Calcific tendinitis of the shoulder, typically characterized by calcium deposits on the rotator cuff, is an extremely painful condition that can severely impair movement and life quality. A new study appearing in today’s issue of the Journal of Bone and Joint Surgery, found a significant increase in blood vessel and pain receptor growth among patients with this condition.

“We found a 3-to-8-fold increase in the number of small blood vessels, nerves and inflammatory cytokines (proteins that direct cell growth) in patients with calcific tendinitis in one of four rotator cuff tendons, as compared to patients with a torn yet normal tendon,” said George A.C. Murrell, MD, an Australian orthopaedic surgeon and lead author of the study. “This might explain the chronic inflammation and severe pain that patients with calcific tendinitis often experience.”

In the study, 30 patients received an ultrasound during arthroscopic surgery to identify and remove samples of calcium within the shoulder tendon. Each patient had calcific tendinitis, but no prior surgeries or fractures in the affected shoulder, and no history of rheumatoid arthritis or osteoarthritis. They were compared to similar patients with tears in normal rotator cuff muscles, without calcification or rheumatoid arthritis, and patients with healthy rotator cuff muscles.

Overall, the results showed significantly elevated blood vessel growth (neovascularization) and nerve growth (neoinnervation) in the calcific tendinitis lesions. In addition, the calcific tendinitis group had more frequent pain during sleep and more extreme pain in general. The findings are similar to, but much more pronounced than, those found in studies looking at patients with frozen shoulder and other tendon disorders and diseases.

“To our knowledge, few works have investigated the presence and/or role of immune cells and their molecular messengers in calcific tendinitis,” said Dr. Murrell. “The results could lead to new ways to manage the pain associated with this condition.”

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