Chronic Pain More Common Than Diabetes And Depression

May 19, 2023 / Thomas Cohn, MD

New data from the National Institutes of Health found that new cases of chronic pain are being reported at higher rates than diabetes, depression and high blood pressure.

The research, based on data from an annual survey form the Centers for Disease Control and Prevention, surveyed adults on how often they experienced pain in the previous three months. In the survey, chronic pain was defined as having pain on most days or every day over that three-month period. The results were then compared to the responses of more than 10,000 respondents in 2019 and 2020. Researchers then worked to determine the rate of new cases that developed over that period using a metric called person-years, which took into account the number of people in the study and the amount of time between survey responses.

An analysis of the data found that new chronic pain cases were developing at an alarming rate. Researchers found that there 52 new cases of chronic pain per 1,000 person-years, which outpaced the rate of new cases of high blood pressure (45 new cases per 1,000 person-years). The chronic pain rate was also far higher than the new case rate of depression and diabetes. The team also noted that of those without any pain in 2019, 6.3 percent reported new chronic pain in 2020.

“What we’re finding is, to nobody’s surprise, we have an astounding problem of pre-existing chronic pain in this country and a huge amount of people who are developing chronic pain as each year goes by,” said Dr. Sean Mackey, chief of pain medicine at Stanford University School of Medicine, who wasn’t involved in the research.

Concerning Data On Chronic Pain

High blood pressure is still more prevalent, but chronic pain is closing the gap as new cases outpace hypertension. Data shows that around 48 percent of adults had high blood pressure between 2017 and 2020, while 21 percent of the more than 10,000 surveyed adults reported chronic pain. That outpaces the 19 percent of U.S. adults with depression, and the rates of diabetes, heart disease and asthma, which all sit under 10 percent.

So while high blood pressure may still be a greater threat to the nation as a whole, the findings on chronic pain should be eye opening on a national level. It is great to see that this study is getting attention from large outlets like The New York Times, USA Today and NBC News, but covering the issue is only part of the puzzle. We also need to commit a lot more funding to treatment-focused studies. Understanding that chronic pain is a problem is helpful, but now that the national burden is under the spotlight, we need to put resources towards improving our understanding of how to best treat this highly individualized condition.

Another silver lining to take away from this study is the knowledge that if you are suffering from chronic pain, you certainly aren’t alone. More new cases are being diagnosed than many other serious conditions, and while that’s not great news in and of itself, it does mean that it should be easier to connect with others and with doctors who are familiar with your plight.

If you have questions about chronic pain or a condition that you’re battling, let us be a resource. Reach out to Dr. Cohn and his team today at (952) 738-4580.

The Relationship Between Diabetes, Vitamin D, & Pain

December 9, 2013June 24, 2014 / Thomas Cohn, MD

A research presentation at the University of Chicago has indicated that vitamin D may have an effect on pain and depression in patients with type-2 diabetes. The study indicates a relationship between pain and vitamin D supplementation. Those with low vitamin D levels, who then received vitamin D, then had less pain complaints. The study just shows that these problems of diabetes with pain and vitamin D have some connection.

Secondary Problems

As with many medical problems, many secondary problems can occur with diabetes. Diabetes causes problems with multiple body systems, including the kidneys, eyes, blood vessels, and the nerves among many organs it damages. It is no surprise that diabetes can affect vitamin D levels. Whether treating diabetes more successfully and comprehensively is the answer or vitamin D has a correlation to pain levels is not known. The study just notes that there is some sort of relationship.

Diabetes can cause multiple health problems. Controlling diabetes is the most important way to prevent complications. Pain is often a complication of the disease due to damage to the vascular system and nervous system. Vitamin D may turn out to be an important aspect of controlling aspects of diabetes. However, it is unlikely it will be a solution to pain in diabetes. The first and most important aspect in reducing pain in diabetes is to keep control of the blood sugars. Most pain in diabetes is related to nerve damage, and neuropathic medications like Neurontin, Lyrica, and Cymbalta are some of the best at reducing pain symptoms.

More Research Needed

New research in pain control in any disease is welcome. The most important thing in any medical study is understanding what the researchers have found. In this study, researchers found that patients with diabetes type 2 and depression often have vitamin D deficiency. The relationship between all these variables at this point is interesting but needs further study before any definite conclusions can be drawn.

Diabetic Neuropathy: Types, Causes, & Pain Management Options

November 4, 2013June 24, 2014 / Thomas Cohn, MD

Diabetes can cause multiple problems in the body. High blood sugars can cause damage to nerves. Diabetic neuropathy occurs in up to 70% of diabetics, and is painful in up to 30%. There are four common types of diabetic neuropathy:

Peripheral polyneuropathy
Autonomic neuropathy
Amyotrophy mimicking a radiculopathy
Mononeuropathy

The small sensory pain fibers are the most commonly affected, causing pain in the feet and slowly progressing to the legs and often developing in the hands. Loss of sensation in the legs can lead to open wounds, infections, amputations, and sometimes even death.

Causes of Diabetic Neuropathy

The causes of diabetic neuropathies are all thought to start with high blood sugars. This is known to cause damage directly to the nerve, the insulation covering the nerves, and the blood vessels that provide nutrition. There is also thought to be an auto-immune factor that diabetes provokes our immune system to fight the body itself like a foreign organism and cause damage. Smoking and alcohol can also increase the likeliness of damage. Lastly, diabetes makes the nerves more sensitive to damage, thus injury can cause significant increase in overall damage to nerves.

Peripheral Polyneuropathy

Peripheral polyneuropathy is the most common type of damage seen in diabetes. It is noticed first affecting sensory nerves, but motor nerves can be equally damaged. People often first notice numbness in the feet and toes, and changes in temperature. Tingling, and burning is common, as well as pain and sensitivity even to the lightest of touches. Motor changes include weakness in the feet and legs and difficulty with walking and balance.

Autonomic Neuropathy

Autonomic neuropathy is the next most common diabetic neuropathy. The nerves that control the heart, bladder, stomach and intestines, sex organs, and eyes are from the autonomic nervous system. Loss of control of the bladder may be from damage to these nerves. In males, erectile dysfunction is a common issue. Stomach problems include slow emptying, constipation, and sometimes diarrhea. Heart problems include fluctuating blood pressures and heart rates.

Prevention & Treatment Options

Once diabetic neuropathies occur, they are often hard to manage and control, since the nerve damage is often permanent. Good blood sugar control is the most important aspect in reducing the incidence and severity. Painful neuropathies are best treated with neuropathic medications such as:

Gabapentin
Lyrica
Cymbalta

Narcotic/opioid medications are often only minimally helpful at best. In the worst cases, implantable pain control devices such as spinal cord stimulation and intrathecal pain pumps are useful. When pain is an ongoing problem, enlisting the help of an experience pain physician can be a lifesaver in symptom management.