Ortho-McNeil funds survey

Five years after it first asked patients and physicians about chronic pain, Ortho-McNeil Pharmaceuticals funded a follow-up survey that revealed more recent perceptions about pain and pain management.

In telephone surveys, New York-based Louis Harris & Associates Inc. interviewed 1,000 randomly selected adults who reported having chronic pain that caused them to take prescription medicines for relief. The company also surveyed 500 physicians: 250 primary care physicians and 250 specialists who treat chronic pain (excluding those who specialize in treating cancer pain).

In 1994, survey results revealed that many people suffering from chronic pain were reluctant to take certain types of drugs because of fears about side effects such as gastrointestinal bleeding and the potential for addiction. Physicians also expressed similar concerns, leaving the survey analysts to conclude that pain sufferers faced an "analgesic dilemma."

Although new pain medications with different side effect profiles have become available since the 1994 survey, the 1999 survey revealed that patients and physicians share many of the same concerns they did five years ago.

Where it hurts

According to Louis Harris & Associates, roughly 48 million people suffer from chronic pain, or pain that lasts for six months or longer. Nearly half of those take prescription pain medication regularly to manage that pain; women more so than men, older adults more so than those under the age of 45.

The most common reasons why people take pain medications, according to those surveyed, are arthritis (31%), lower back pain (25%), other types of bone or joint pain (17%), muscle pain or stiffness (13%) and fibromyalgia (12%). Despite treatment, two out of five said the pain was so bad they were unable to work, and three out of five said they were unable to perform daily tasks of living because of their pain.

Of the prescription drugs available for pain management at the time of the survey (COX-2 inhibitors had not yet been approved), NSAIDs were the most commonly used (28%) and oxycodones/ hydrocodones were second (16%). Propoxyphenes were also used by 11% of those surveyed, and 4% reported using tramadol, the Ortho-McNeil pain drug driving the company's interest in the data.

The majority of pain sufferers (88%) take prescription pain medicines at least once per day, and many take them over a long period of time. According to the survey, one in four take a prescription drug once per day, three in 10 take pain medicines twice per day and another one in three take them several times per day. For those using NSAIDs, the median time of use was 20 months.

Considering all the medicating they are doing, it's fortunate that nine in 10 patients and most physicians think prescription pain drugs are effective in controlling pain. However, 62% of pain sufferers say their medicines "work better on some days than others" and 41% have asked their physicians to change their prescription at some point. Ineffectiveness is the leading cause for change requests, according to 59% of patients surveyed.

Physicians cited side effects and potential for addiction as the other two reasons why they change patients' prescriptions. One in four of the 31% of patients who said they experienced side effects from the medicines said they take other medication to manage the side effects - primarily gastrointestinal ones.

Half of those with chronic pain are reluctant to take certain types of pain medicines, citing side effects (50%), potential for addiction (20%) and stomach problems (12%). More than 60% of physicians are perceptive enough to know that chronic pain patients have this reluctance, and virtually all physicians expressed their own reluctance to prescribe certain types of pain medications. They cited potential for addiction (57%), side effects (40%) and a history of addiction or abuse (20%) as reasons for their hesitation. PR