Pain in Europe Survey Pan-European Results. The Pain in Europe Research Largest survey ever undertaken into pain -Prevalence data based on >46,000 interviews.

Pain in Europe Survey

Pan-European Results

The Pain in Europe Research

Largest survey ever undertaken into pain

- Prevalence data based on >46,000 interviews

- Attitudinal data from almost 5,000 interviews

Striking results demonstrate the devastating impact of chronic pain

ObjectivesEstimate the prevalence of chronic pain conditions across Europe

Understand and quantify the sources and causes of chronic pain;

Explore the demographics of sufferers;

Explore the impact of pain on sufferers’ quality of life

Understand current treatment practices & levels of satisfaction

Explore the attitudes of sufferers toward and experiences with pain

Methodology

MethodologyCATI (Computer Assisted Telephone Interviewing), random dialling

Screener Questionnaire (2,900 average)- Determine the prevalence of chronic pain

by country

Detailed Questionnaire (300)

Inclusion Criteria- Adult (18 years old or older);- Suffered pain for at least 6 months

duration- Has experienced pain within the past

month- Experienced pain at least several times a

week- Pain intensity >5/10- Has not participated in medical studies.

Country Phone Screen

Structured Phone Interviews

UK 3,800 300

France 3,846 300

Germany 3,832 302

Italy 3,849 300

Spain 3,801 301

Poland 3,812 300

Sweden 2,563 300

Norway 2,018 304

Denmark 2,169 303

Country Phone Screen

Structured Phone Interviews

Netherlands 3,197 300

Belgium 2,451 301

Finland 2,004 303

Ireland 2,722 300

Switzerland 2,083 300

Austria 2,004 303

Israel 2,244 322

Total 46,394 4,839

Pain in Europe: Countries Covered

The Data

Prevalence

Pain - A Widespread ProblemStrikes almost one in five adults across Europe = 19% (75 million people)

- Prevalence highest in Norway, Poland and Italy (>one in four)

- Prevalence lowest in Spain, but still more than one in ten (11%)

One-third of all European households are affected by chronic pain

Prevalence of Chronic Pain by Country– Based on Complete Screener Data –

14%

13%

12%

17%

15%

13%

19%

21%

8%

13%

8%

9%

4%

5%

7%

4%

0% 50%

5%

8%

9%

10%

10%

10%

7%

12%

6%

6%

10%

5%

5%

4%

5%

6%

0% 50%

SevereModerate

Norway (n=2,018)

Poland (n=3,812)

Italy (n=3,849)

Belgium (n=2,451)

Finland (n=2,004)

Austria (n=2,004)

Sweden (n=2,563)

Netherlands (n=3,197)

Germany (n=3,832)

Israel (n=2,244)

Denmark (n=2,169)

Switzerland (n=2,083)

France (n=3,846)

UK (n=3,800)

Ireland (n=2,722)

Spain (n=3,801)

30%

27%

26%

23%

21%

19%

18%

18%

17%

17%

16%

16%

15%

13%

13%

11%

Overall Prevalence = 19% (n=46,394)

Moderate 13% Severe 6%

Overall Prevalence = 19% (n=46,394)

Moderate 13% Severe 6%

4

8

22

20

17

8

21

0

5

10

15

20

25

6 Months to <1 Year

1 to <2 Years

2 to <5 Years

5 to <10 Years

10 to <15 Years

15 to <20 Years

20 Years or More

Source: SQ6. For how long have you suffered from pain due to your illness or medical condition?

Duration of Pain Reported by Chronic Pain Sufferers(n=4,839)

Patients Forced to Live in PainOn average, sufferers live with chronic pain for 7 years

A fifth suffer with pain for more than 20 years

%

Source: SQ8. How often do you experience pain? (Read list) SQ7. When was the last time you experienced pain? (Read list)

How Often Does it Hurt?One third of sufferers report experiencing chronic pain all the time

35%

31%

34%

At All Times Daily Several Times a Week

Frequency (n=4,839)

Nature of Chronic Pain

Source: SQ11. Where is your pain located? SQ12. Please tell me the illness or medical condition that is the cause of your pain. Q1. Is your pain caused by…?

7

6

4

4

4

3

34

15

12

8

0 5 10 15 20 25 30 35 40

Arthritis/osteoarthritis

Herniated/deteriorating discs

Traumatic injury

Rheumatoid arthritis

Migraine headaches

Fracture/deterioration of spine

Nerve Damage

Cartilage Damage

Whiplash

Surgery

Most Common Causes of Pain Reported by Chronic Pain Sufferers(n=4,292)

Where does it hurt?The most frequent cause of chronic pain is arthritis / osteoarthritis (34%)

The most common location is the lower back

%

Source: Q4. Thinking about the intensity of your pain when it was at its worst, which of the following statements best describes your tolerance level of this pain?

Tolerance Level for More Pain(n=4,785)

31% 47% 18% 4%

0% 100%

My pain was so severe, Icould not tolerate any more

I could tolerate a little morepain

I could tolerate somewhatmore pain

I could tolerate a lot morepain

And How Much?One third reported that their pain was so severe they could not tolerate any more

Quality of Life

Chronic Pain is Insidious

Over 40% of sufferers report feelings of helplessness or inability to think or function normally

One in six say the pain is sometimes so bad they want to die

0 10 20 30 40 50 60 70 80 90

My pain is just part of my medical condition

I feel tired all the time

Being in pain makes me feel helpless

My pain keeps me from thinking or concentrating clearly

I cannot function normally

I cannot remember what it feels like not to be in pain

I feel much older than I really am

I feel alone with my pain

I am in too much pain to take care of myself and other people

Some days the pain is so bad, I want to die

* Higher=Agree more strongly with the statementSource: Q37. Now we would like to understand how pain affects your life. I am going to read a list of statements that could be used to describe how people who are experiencing pain think and feel about it. For each statement I read, please think about yourself and your own pain and tell me how much you agree or disagree with each statement using a

5-point scale where 1=Disagree Completely, 2=Disagree Somewhat, 3=Neither Agree nor Disagree, 4=Agree Somewhat, and 5=Agree Completely. (Read list)

Chronic Pain is Insidious

%

And Can Devastate Lives

Chronic pain has an undoubted impact on the daily lives of sufferers

Chronic pain impacts on daily activities such as lifting, exercising, sleeping and working outside

One quarter (26%) feel that their pain impacts employment

15 working days a year are lost to pain (estimate on 6 month data)

One in five reports

- losing a job (19%)

- or have been diagnosed with depression as a result of their pain (21%)

Source: Q6a. Have any of the following ever happened as a result of your pain…? (Read list) Q6b. Have you ever been diagnosed with depression by a medical doctor as a result of your pain?

And Can Devastate Lives

WeightedTotal

UK (n=243)

France (n=232)

Germany (n=232)

Italy (n=233)

Spain (n=255)

Poland (n=220)

Sweden (n=292)

Norway (n=289)

Denmark (n=298)

Lost job 19% 25% 15% 14% 17% 22% 14% 24% 24% 29%

Changed job responsibilities

16% 16% 12% 11% 28% 8% 19% 28% 28% 21%

Changed jobs entirely

13% 18% 12% 8% 20% 4% 13% 25% 22% 11%

Been diagnosed with depression

21% 24% 18% 20% 22% 29% 14% 24% 28% 11%

And Can Devastate Lives

Netherlands (n=294)

Belgium (n=286)

Finland (n=290)

Ireland (n=272)

Switzerland (n=274)

Austria (n=279)

Israel (n=299)

Lost job 29% 15% 22% 15% 16% 20% 25%

Changed job responsibilitie

s20% 9% 19% 24% 15% 20% 17%

Changed jobs entirely

16% 9% 14% 23% 12% 11% 14%

Been diagnosed

with depression

19% 19% 22% 19% 18% 21% 16%

Doctors and Patient Relationships Revealed

Patients See Different Clinicians But Rarely Pain Specialists

Consultations were most frequently with GPs

Orthopaedists and to a lesser degree Rheumatologists and Neurologists are also seen

Only 23% report seeing an actual pain specialist

* Other includes Alternative Medicine/Homeopathy, Anesthaesiologist/Anesthaetist, Cardiologist, Chiropractor, Ear Nose Throat, Gastroenterologist, Gynecologist, Hematologist, Infectious Disease, Oncologist, Ophthalmologist, Physical Medicine, Plastic Surgeon, Psychiatrist, Pulmonoloigst, Radiologist, Sports Medicine, and Urologist.Source: Q12c. What kinds of doctors are you currently seeing specifically for your pain? Q12d. Have you ever been to see a pain management specialist?

Chronic Pain Patients See Many Different Clinicians

Physician Specialty % Who See

General/Family Practitioner

Orthopaedist/Orthopaedic Surgeon

Rheumatologist

Neurologist//Neurosurgeon

Internist

Physiotherapist

General Surgeon

Pain Management Specialist

Osteopath

Other *

When asked specifically whether ever been to a pain management specialist

70%

27%

9%

10%

7%

6%

3%

2%

2%

20%

23%

3

26

36

28

7

0

5

10

15

20

25

30

35

40

Extremely Satisfied Very Satisfied Somewhat Satisfied Not Very Satisfied Not at All Satisfied

* Higher = betterSource: Q14d. How satisfied are you with the doctor who currently treats your pain? (Read list) Q14e. Why do you say you are not very/not at all satisfied with the doctor who currently treats your pain?

Doctors DefendedThe majority (62%) are very or extremely satisfied with the doctor who treats their pain have seen them 1.3 times in last six months

%

But There are Still Problems

Some patients worry about their doctor’s willingness and commitment to treating their pain

A sizeable proportion (43%) of chronic pain sufferers believe that their physicians are more focused on their illness than their pain

In making a diagnosis or deciding on treatment, few doctors use pain rating scales (10%)

Most discussions are patient initiated

Source: Q37. disagree with each statement using a 5-point scale where 1=Disagree Completely, 2=Disagree Somewhat, 3=Neither Agree nor Disagree, 4=Agree Somewhat, and 5=Agree Completely. (Read list)Source: Q13c. How does the doctor who generally treats your pain determine how much pain you are in? Q14a. Has any doctor or medical professional ever scored you on a pain scale?

2

2

1

71

52

15

11

0 10 20 30 40 50 60 70 80

I tell him/her

Doctor examines me

Doctor asks me to move the part of my body that is in pain

Doctor asks me to walk

Doctor uses a pain scale

Doctor does nothing

Other

But There are Still Problems

%

Feelings about Treatments

Two thirds of sufferers are always willing to try new treatments

But almost as many are worried about potential side effects of pain medication

* Higher=Agree more strongly with the statement Source: Q37. Now we would like to understand how pain affects your life. I am going to read a list of statements that could be used to describe how people who are experiencing pain think and feel about it. For each statement I read, please think about yourself and your own pain and tell me how much you agree or disagree with each statement using a

5-point scale where 1=Disagree Completely, 2=Disagree Somewhat, 3=Neither Agree nor Disagree, 4=Agree Somewhat, and 5=Agree Completely. (Read list)

Feelings about Treatments

0 10 20 30 40 50 60 70

I am always willing to try a new treatment forpain

I worry about the side effects of painmedicine

I would rather take medication for my illnessthan my pain

I would spend all my money on paintreatment if I knew it would work

I am afraid of being addicted to painmedicine

My pain is not severe enough to take painmedicine

I am taking so many medicines, I don't wantto take pain medicine too

%

Use of Prescription Medicines

Pain sufferers are proactive with 69% of chronic pain sufferers treating their pain in some way, mainly via prescription medications

Over one in four (26%) have tried then stopped taking prescription pain medication

53%

21%

26%

Lapsed

Never Taken

Currently Taking

Source: Q11a. Is your pain currently being treated in any way? Q15a. Have you ever taken prescription medicine for your pain? Q16a. Are you currently taking prescription pain medicine?

Chronic Pain Sufferers Reporting Currently Treating Their Pain in Any Way

(n=4,827)

69%

31%

Not Treating Treating

Use of Prescription MedicationsTo Treat Chronic Pain

(n=4,839)

Use of Prescription Medicines

Use of Prescription Medicines

NSAIDs (44%) are most used class of pain medication

Other commonly prescribed drugs are weak opioids (23%) and paracetamol (18%)

Mean number of pills taken everyday is 3.4

44

18

63 3

325

23

0

5

10

15

20

25

30

35

40

45

50

NSAID Narcotic Analgesic

Paracetamol COX-2 Inhibitor

Barbiturate Ergotamine

Tricyclic/SSRI/SNRI

Triptan Anti-Epileptic

Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing?

Use of Prescription Medicines%

Weak Opioids

Strong Opioids

Classes of Prescription Pain Medications Chronic Pain Sufferers Report Currently Using for Pain – European Summary –

(n=2,063)

Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing?

44%

23%18%

6% 5% 3% 3% 3% 2% 2% 1% 1%0%

50%

WeightedTotal

UK (n=300)

France (n=300)

Germany (n=302)

Italy (n=300)

Spain (n=301)

Poland (n=300)

Sweden (n=300)

Norway (n=304)

Denmark (n=303)

NSAIDs 44% 23% 25% 54% 68% 49% 71% 27% 24% 38%

Weak Opioids 23% 50% 19% 20% 9% 13% 28% 36% 50% 8%

Paracetamol 18% 38% 38% 2% 6% 8% 8% 26% 45% 0%

COX-2 Inhibitors 6% 3% 6% 8% 7% 2% 1% 7% 11% 8%

Strong Opioids 5% 12% 4% 4% 0% 1% 4% 3% 6% 11%

Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing? (most common mentions)

Netherlands (n=300)

Belgium (n=301)

Finland (n=303)

Ireland (n=300)

Switzerland (n=300)

Austria (n=303)

Israel (n=322)

NSAIDs 36% 42% 54% 32% 48% 58% 53%

Weak Opioids

14% 15% 22% 19% 18% 14% 5%

Paracetamol 11% 33% 26% 5% 12% 4% 3%

COX-2 Inhibitors

16% 13% 16% 8% 13% 4% 36%

Strong Opioids

5% 7% 2% 13% 2% 5% 5%

Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing? (most common mentions)

Source: Q18. Which prescription pain medicines are you currently taking for the specific pain we have been discussing?

Use of Non- Prescription Medicines

Non-Prescription (OTC) Classes and Medications Chronic Pain Sufferers Report Currently Using for Pain

(n=1,914)

55%

43%

13%

0%

100%

NSAID Paracetamol Weak Opioid

Alternative Therapies

233

45

98

10

13

21

31 30

3

0

5

10

15

20

25

30

35

None

Massage

Physical therapy

Acupuncture

Ointm

ent/creams

Heat

Exercise

Nerve stim

ulation

Relaxation therapy

Diet/special foods

Cold

Herbal supps

Therapy

%

Source: Q28. What other methods, remedies or treatments, apart from medications have you ever tried to relieve your pain for the medical condition or illness we have been discussing?

How Patients Rate Treatments

The majority (64%) of pain sufferers feel their treatment is inadequate at times

Chronic pain sufferers report that there is considerable room for improvement in the effectiveness of pain treatments

Source: Q21. Do you ever experience an increase in pain during the day as a direct result of an activity you did? Q20. Are there ever times when your pain medicines are not adequate to control your pain?

Adequacy of Pain Control from Medication

(n=2,450)Pain from Activity

(n=4,787)

21%

79%

Experience Pain from Activity

Do Not Experience Pain from Activity

36%

64%

Pain Medication Inadequate at Times

Pain Medication is Adequate

How Patients Rate Treatments

Source: Q36. Where do you hear about new methods for treating pain?

Learning About New Pain Treatments

Over one quarter of all chronic pain sufferers feel they never hear about new methods of treating pain

Majority rely on newspapers, TV and magazines

Just 5% surf the ‘Net for new options

Source: Q36. Where do you hear about new methods for treating pain?

Where Chronic Pain Sufferers Report Hearing About New Pain Treatments

(n=4,586)

5 4

27

39

33

24

14

0

5

10

15

20

25

30

35

40

45

Magazines/Newspapers

Television Doctor's Office Friends, Family,Coworkers

Internet Pharmacy Do Not HearAbout NewMethods

Learning About New Pain Treatments

%

The Largest Pain Survey in the The Largest Pain Survey in the WorldWorld