US Pharm. 2015;40(3):22.

Pain is considered chronic if it persists for 6 months or more. The Institute of Medicine reported that 33% of Americans (116 million) have chronic pain. In 2006, the National Center for Health Statistics determined that 76.2 million—one in every four—Americans experienced pain lasting longer than 24 hours and millions had acute pain. Fifty percent of those with chronic pain experienced daily pain, and 32% had severe pain. Lower socioeconomic status was associated with a higher prevalence of pain, particularly headache. The combined direct and indirect costs of chronic pain have been estimated at $635 billion, and the National Institute for Occupational Safety and Health estimates the annual cost attributable to lost workdays, medical expenses, and other benefits at $100 billion.

Sex and Age: Non–disease-related chronic pain was found to be common during childhood and adolescence. More women (34.3%) than men (26.7%) experience chronic pain. The prevalence of chronic pain was determined to increase with age, contributing to restricted functional activity and difficulty performing activities of daily life.

Types of Pain: The lifetime prevalence of spinal pain ranges from 54% to 80%. Although there is great variability in the prevalence of headache (8%-83%), abdominal pain (4%-53%), back pain (14%-24%), musculoskeletal pain (4%-40%), multiple pains (4%-49%), and other pain (5%-88%), lower-back pain is most common (8.1%), followed by pain secondary to osteoarthritis (3.9%). In a lifetime, 60% to 80% of Americans experience lower-back pain. Nonprescription or OTC pain relievers are generally used for mild-to-moderate pain, and prescription pain relievers are used for moderate-to-severe pain. Opioids and nonsteroidal anti-inflammatory agents may be used to achieve symptomatic relief from chronic pain in patients without cancer.

Pain-Reliever Misuse and Abuse: Analgesics (11.5%) are among the top five substance categories most frequently involved in human poisonings, according to the National Poison Data System. In 2005, one in four people who used OTC pain relievers daily took more than the recommended dose. The National Survey on Drug Use and Health reported that 31.8 million Americans have used pain relievers nonmedically in their lifetime. Drug overdose is the leading cause of injury-related deaths. Unintentional excessive use of prescription painkillers caused 12,000 deaths in 2007, whereas nonmedical use of painkillers contributed to a doubling of emergency department (ED) visits between 2004 and 2009. Opioids are one of the most frequently used drugs associated with poison-related deaths. Of the 1 million ED visits reported in 2009, 34.3% were due to prescription opioid pain relievers, the highest rate in 5 years, according to the Drug Abuse Warning Network.

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