Angus Reid: Canadians in Chronic Pain: Cost, access to treatment pose significant barriers for those suffering the most

Press Release

July 12, 2019 – For many Canadians, the activities and experiences that many of us take for granted are significantly hindered by something unseen by the naked eye: persistent, ongoing pain.

A new public opinion survey from the non-profit Angus Reid Institute, in partnership with Pain BC and Mindset Social Innovation Foundation, delves deeply into the lives of those who experience ongoing pain, in order to better understand its causes, effects and potential resolutions.

Overall, one-in-three Canadian adults (34%) say they are currently experiencing some form of pain that has lasted longer than three months. That said, for a core group of one-in-five (22%), that pain is considered significant, due to the considerable emotional and physical impact it has on their day-to-day activities. This represents millions of people within the Canadian population who are living with moderate to severe pain that interferes with their lives.

From their working lives, to sleeping habits, to personal relationships and mood, the often-invisible consequences of chronic pain are a harsh reality for many.

Consider that four-in-five Canadians experiencing significant ongoing pain (83%) say it prevents them from doing regular activities, and for more than half (57%), it contributes to anxiety and depression. Indeed, among those living with significant chronic pain, 23 per cent say they experience feelings that “life isn’t worth living.”

The importance of this issue is evident to nearly all Canadians. More than nine-in-ten say that every Canadian – regardless of income – should have access to pain treatment that works for them. This is not the current reality for many, however. Two-thirds of those experiencing ongoing pain (64%) say that if they could afford to pay for more of the available treatments offered, their discomfort and quality of life would be improved.

Canadians – whether they have personal experience of ongoing pain – are overwhelmingly supportive of proposed policy changes that could alleviate pain. Such proposals include increasing subsidies for those who cannot afford the treatments they need (89% say this would be worthwhile for government to pursue), to supporting more funding for research on effective therapies (89%), to increasing the number of treatments that are covered as a part of public health care (88%), this is an area of strong public support.

More Key Findings:

• Lower-income households and women over the age of 35 significantly overrepresented in their prevalence of living with chronic pain

• Three-quarters of Canadians who say they experience ongoing pain have had it for more than three years (76%). For three-in-ten (29%), this pain has lasted more than a decade

• Eight-in-ten Canadians (79%) say they are concerned about the abuse of opioids due to pain. Among those who experience long-term pain, 17 per cent say they avoid opioids entirely and one-quarter (25%) curtail their usage of these types of medications because of health concerns

• A sizable minority of Canadians living with chronic pain, including nearly four-in-ten (37%) of those with severe pain, have experienced difficulties in accessing prescription pain drugs because of their doctor’s or the healthcare system’s concerns about addiction and abuse

• Cannabis is reported as effective by three-quarters (74%) of those who have used it to treat their pain. This is the highest number among all physical or medicinal treatment methods
• Canadians are near-unanimous (92%) in their agreement that those living with pain should have access to pain treatment that works for them, regardless of income

About ARI

The Angus Reid Institute (ARI) was founded in October 2014 by pollster and sociologist, Dr. Angus Reid. ARI is a national, not-for-profit, non-partisan public opinion research foundation established to advance education by commissioning, conducting and disseminating to the public accessible and impartial statistical data, research and policy analysis on economics, political science, philanthropy, public administration, domestic and international affairs and other socio-economic issues of importance to Canada and its world.

INDEX:

Part 1: Prevalence and Impact of Pain

• Women more likely to live with ongoing pain
• Income is a factor
• Living with pain

Part Two: The Pain Experience

• Pain Experience Index
• Who suffers least and most?
• Emotional and Psychological Impacts
  • One-in-five have felt life not worth living
  • Frustration and hopelessness
• Physical Impacts

Part Three: Accessibility and Assessment

• How Canadians treat their pain
• Which treatments work best?
• Costs prevent many from accessing care
• Those in pain are more critical of provincial healthcare
• Doctors graded mostly favourably

Part Four: Remedies and Policy Propositions

• Consensus on value of more support from government
• What should be covered?
• Opioids a source of anxiety; barriers to access remain

Part 1: Prevalence and Impact of Pain

Chronic pain affects millions of people in Canada and costs the country tens of billions of dollars in medical care and lost work. The medical system has, by many estimates, failed to keep pace, with treatment of this pain.

To understand prevalence, Canadians were asked whether they have had noticeable pain that either lasts or recurs for more than three months. One-in-three Canadians (34%) meet this definition. This statistic is significant, given that studies have found that Canadians dealing with chronic pain suffer from a worse quality of life than those dealing with chronic diseases such as lung or heart disease. Those in severe pain will be discussed in more detail throughout this report.

Women more likely to live with ongoing pain

Chronic pain is an experience that more than half of the population says they have dealt with at some point in their lives, with women over 35 reporting at the highest rates. Young men, meantime, are the least likely to say they’ve been dealing with this issue in an ongoing manner, though 16 per cent still do:

It is also worth noting that two-thirds of those dealing with pain are over the age of 45. Indeed, that age appears to be a key marker for separating Canadians who are currently dealing with ongoing pain, as seen in the following graph:

Income is a factor

There is a notable income angle to this discussion as well, which speaks to some of the broader issues that will be discussed in this study, including access to treatments and cost. The proportion of those dealing with chronic pain issues is considerably higher among Canadians with household incomes under $100,000 a year. The occurrence of chronic pain drops significantly at this income cut-off point:

Living with pain

Looking at the one-third of Canadians who self-identify as living with chronic pain, one can see a range of lived experiences. For example, the severity of pain diverges significantly. Most (61%) say that on average their pain is moderate, though more than half also say that, at its worst, the pain is severe (46%) or as bad as they could imagine (12%):

The length of time Canadians have spent with this pain is also varied. Older Canadians are much more likely to have been dealing with pain for a longer period of time, as one might expect, but notably, a significant portion of those who experience pain in all age groups have been dealing with this for at least three years. Among those over the age of 35, three-in-ten have been dealing with this pain for more than a decade:

Beyond personal experience, a significant number of Canadians are surrounded by chronic pain in their lives. More than half (54%) say they have a friend or family member dealing with this type of issue, and one-quarter (25%) say they spend time with someone who does.

Further, approximately one-in-ten Canadians (9%) are involved in caring for someone who has difficulties related to chronic pain. These measures of exposure help to provide a more contextualized picture. The table below shows the full slate of Canadians’ exposure to chronic pain:

Part Two: The Pain Experience

Pain Experience Index

The Angus Reid Institute was able to further segment individuals living with chronic pain into groups based on degrees of intensity and experience with pain, including the emotional and functional impact it has on their lives.

While the methodology and terminology used when discussing this topic can oftentimes change, in this report the Angus Reid Institute will focus in on this group of one-in-five Canadians living with “significant” pain. This group is categorized as being Severely or Moderately Affected by their pain. Others are relatively encumbered, i.e. Minimally Affected, but risk joining the two other groups if their pain worsens or persists.

As a percentage of the general population, the distribution breaks down as follows:

Who suffers least and most?

Note that everyone within these three groups, the Severely Affected, Moderately Affected and Minimally Affected, said they experience some ongoing pain that has lasted at least three months. That said, their experiences and the impact of their pain diverge significantly (See methodology at the end of this report).

There are also notable demographic differences between these groups.

First, women are found in each of the three groups at much higher rates than their male counterparts. Further, they are significantly overrepresented in the most extreme group, the Severely Affected, accounting for two-thirds (67%) of that population:

The age and gender distribution of the Severely Affected group indicates just how much Canadian women over 35 are shouldering the burden of chronic pain. Approximately six-in-ten (58%) of those in this Severe group are women over 35, with one-third over the age of 55.

Importantly, those who are experiencing pain across each of the three groups are more likely than the general population to have lower income levels. Further, those Severely Affected by pain are much more likely than the other cohorts to have household incomes under $50,000. Meanwhile, the Minimally Affected are twice as likely to have incomes over $150,000.

This becomes increasingly relevant when discussing access and affordability issues, which we will do shortly:

Emotional and Psychological impacts

In order to understand pain in Canada, it is worth considering how these lingering issues can affect a person’s life, both physically and emotionally.

These impacts are a key input in understanding and categorizing the three levels of ongoing pain (see methodology at end of report).

Overall, one-in-three Canadians (31%) who currently experience pain say it interferes significantly with their mood day-to-day. Another one-in-three (34%) say they feel a negative impact “to some degree.” Those in the Moderately Affected group are most likely to choose this middle option, while the Severely Affected are far and away the most negatively impacted when it comes to their mood:

Perhaps unsurprisingly then, those who have the most difficulty keeping their spirits up because of their pain are also the most likely to feel their relationships are being harmed because of how they feel physically. Two-thirds of Canadians in the Severe group say their relationships have been strained:

One-in-five have felt life not worth living

Among the Severely Affected, psychological impacts are particularly prevalent. Two-thirds (66%) from this group say they experience stress and anxiety as a result of their pain and 57 per cent say it has led them to depression. Those who are Severely Affected are also considerably more likely than those with Moderate or Minimal Pain to feel isolated, lonely or hopeless.

Most troublingly, one-third of those in the Severely Affected group say that they have felt at times that life is not worth living. Long-term pain sufferers are at a significantly higher suicide risk than the general population, and that documented data is affirmed in this study.

Read More: http://angusreid.org/chronic-pain-in-canada/

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