Patient belief in painkiller effectiveness flawed, research finds

More than half of Irish patients with chronic or persistent pain believe strong painkillers can be used to manage their problem in the long term, a new survey has found.

This was one of a number of patient beliefs running contrary to medical guidelines revealed in online research carried out for the Irish Association of Chartered Physiotherapists. The online survey was across a nationally representative sample of more than 1,000 adults.

The survey also found more than half of patients (59 per cent) believe bending and lifting will make chronic pain worse, while two-thirds of elderly patients believe scans will automatically diagnose their pain.

Chronic pain encompasses a wide range of conditions where pain persists for more than three months, with estimates that it affects more than one in 10 of the Irish population.

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Chronic pain is “still very much misunderstood . . . which leads to overuse of painkillers, rather than focusing on strategies to manage pain,” Dr Derek Griffin, a physiotherapist and specialist in pain management said.

“A big problem is a rise in the prescription of opioids. This is despite research evidence showing limited effectiveness for most non-cancer-related pain and serious side-effects such as addiction, depression, overdose or falls.”

The survey found that 88 per cent of young people with chronic pain suffer poor mental health.

“Our emphasis should be on improving patients’ function and quality of life,” Dr Griffin adds.

Societal cost

“Exercise, good sleep quality, relaxation, healthy eating and keeping people at work are all part of a successful treatment plan,” he said.

According to the European Pain Federation, the societal cost of chronic pain due to treatment plans and loss of working hours is more than the totals for cardiovascular disease, cancer and diabetes combined.

Chronic pain and conditions such as fibromyalgia are also not in the long term illness scheme, which provides free medication for longer-term illnesses. "There are no plans at present" for them to be added, the Department of Health said in a statement.

The exclusion of such conditions from the scheme penalises “the most vulnerable”, Keith Swanick, GP and Fianna Fáil Senator said. He suggests a flat fee per prescription be introduced.

The Co Mayo doctor also raised particular concerns for how difficulties are compounded for rural patients with chronic pain.

In Belmullet, where Dr Swanick operates, the nearest pain management specialist is 1 hour 45 minutes away. Dr Swanick would like to see more community physiotherapists, occupational therapists and an expansion of the community hospital network.

Dr Swanick also raised concern over benefits for people with chronic pain. He says that deciding officers who review disability benefits are rarely medical personnel.

‘Unfair system’

“It’s important to get people back to work as soon as they can, for their own mental and physical health, but many people are prematurely taken off their benefits and forced to go back to work.

“It’s a very unfair system for those suffering chronic pain.”

Once employees with chronic pain have returned to work, they are often met with further challenges, says Deirdre Ryan, the chairwoman of patient group Chronic Pain Ireland.

She says there is currently no Irish law that allows employees to apply for flexible working status. “Most employers don’t know or understand pain,” she says.

Ms Ryan is encouraged by the World Health Organisation’s decision to classify chronic pain as a disease in May 2018. The WHO has advised the Health Service Executive to update its coding measures to accommodate the change by 2022.

Ms Ryan said this would enable GPs to write people off from work due to chronic pain rather than a secondary condition and lead to easier access to disability allowance.

A spokesperson for the Department of Social Protection was unavailable for interview.