Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter January 1, 2012

The impact of chronic pain—European patients’ perspective over 12 months

Tony O’Brien and Harald Breivik


Background and methods

Pain Study Tracking Ongoing Responses for a Year (PainSTORY) is a longitudinal study generating some quantitative and limited qualitative data concerning the experiences of individual patients with non-malignant chronic pain. Research was conducted across 13 European countries and a total of 294 patients completed the full evaluation process over 12 months. Adult patients (>18 years old) scoring >4 on an 11-point numeric pain rating scale (NRS-11) for most days during an average week were eligible. Four waves of interviews (W1–W4) were conducted over 12 months and information was recorded regarding pain levels, the impact of pain, pain treatment and treatment-associated side effects.


At 3 months, 95% of respondents rated their worst pain level over the past week as ≥4. Most respondents had felt this pain level for ≥1 year, with 47% of patients reporting NRS-11 scores of 8–10 for >2 years. At 12 months, 93% of respondents still rated their worst pain level over the past week as ≥4. The overall net percentage of respondents with ≥4 pain intensity did not change substantially over 12 months of follow up. However, 40% (119/294) of patients felt their current pain level increased and 41% (121/294) felt their current pain level decreased during this time, with just 18% (53/294) of respondents reporting no change (1% of respondents not stated). At 3 months, 30% of respondents reported being managed by a pain specialist within the last 3 months, decreasing to 13% 9–12 months later. Patients were typically taking a combination of prescribed and non-prescribed medications; approximately 10% at W1 and 14% at 12 months were prescribed a strong opioid. Among those whose current pain level decreased over the year, a slightly lower proportion of patients were taking prescription medication (78%) at 12 months than in either the group with no change to their current pain level (85%), or the group whose pain level increased over the 12 month period (87%). Pain negatively affected quality of life, with respondents reporting difficulties with daily activities, including sleeping, walking, family and social interaction. Approximately half of respondents taking prescription medication reported suffering from ‘constipation and associated symptoms’. In spite of no change in pain intensity, 51% of patients were happy with their pain management at W4.


The heavy individual and societal burden of uncontrolled chronic pain is demonstrated in this study. This silent epidemic has not attracted the focus of attention that it deserves. Despite the significant negative impact on individual quality of life, patients evolve to a position where they believe that chronic pain is inevitable and untreatable.


It is clear that there is a real need for a coordinated response by healthcare providers and planners across European countries. Minimum standards of care should be developed and implemented at national level. Healthcare professionals and students of these disciplines must be educated to recognise, assess and manage pain within a reasonable timeframe. Patients who are not responding to standard measures must have rapid and easy access to a comprehensive, inter-disciplinary pain service.


  1. Conflict of interest

    Conflict of interest statement

    Tony O’Brien has been a consultant on advisory boards for a number of companies, has received honoraria for lectures and advisory board participation as well as participated in the clinical trials of several pharmaceutical companies.

    Harald Breivik has been a consultant on advisory boards for a number of companies, has received honoraria for lectures and advisory board participation as well as participated in the clinical trials of several pharmaceutical and equipment companies.


This survey was supported by funding from Mundipharma International Limited. Ipsos MORI, an independent market research company, helped develop study design and questionnaire, coordinated local recruitment of patients, performed fieldwork, data collection and data processing.

Mundipharma International Limited provided funding for editorial assistance. Editorial assistance was provided by Euro RSCG Life.


[1] Donaldson L. 150 years of the annual report of the chief medical officer: on the state of public health; 2008, in Google Scholar

[2] Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhoy M, Borchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesth Scand 2008;52: 143–8.10.1111/j.1399-6576.2007.01524.xSearch in Google Scholar

[3] Becker N, Bondegaard Thomsen A, Olsen AK, Sjogren P, Bech P, Eriksen J. Pain epidemiology and health related quality of life in chronic non- malignant pain patients referred to a Danish multidisciplinary paincenter. Pain 1997;73:393–400.10.1016/S0304-3959(97)00126-7Search in Google Scholar

[4] Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization Study in Primary Care. JAMA 1998;280: 147–51.10.1001/jama.280.2.147Search in Google Scholar

[5] Kronborg C, Handberg G, Axelsen F. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients. Eur Health Economics 2009;10:5–13.10.1007/s10198-008-0096-3Search in Google Scholar

[6] Langley P, Muller-Schwefe G, Nicolaou A, Liedgens H, Pergolizzi J, Varrassi G. The impact of pain on labor force participation, absenteeism and presenteeism in the European Union. J Med Economics 2010;13: 662–72.10.3111/13696998.2010.529379Search in Google Scholar

[7] Jensen MK, Thomsen AB, Hojsted J. 10-Yearfollow-upofchronic non-malignant pain patients: opioid use, health related quality of life and health care utilization. Eur J Pain 2006;10:423–33.10.1016/j.ejpain.2005.06.001Search in Google Scholar

[8] Thomsen AB, Sorensen J, Sjogren P, Eriksen J. Chronic non-malignant pain patients and health economic consequences. EurJ Pain 2002;6:341–52.10.1016/S1090-3801(02)00023-XSearch in Google Scholar

[9] Eriksen J. Long-term/chronic non-cancer pain. Epidemiology, health-care utilization, socioeconomy and aspects oftreatment. DMedSci thesis-monograph, Copenhagen University; 2004.Search in Google Scholar

[10] Gustavsson A, Bjorkman J, Ljungcrantz C, Rhodin A, Rivano-Fischer M, Sjolund K-F, Mannheimer C. Socioeconomic burden of patients with a diagnosis related to chronic pain—register data of 840, 000 Swedish patients. Eur J Pain 2011;15 [Epublished before print September 2011].10.1016/j.ejpain.2011.07.006Search in Google Scholar PubMed

[11] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur Pain 2006;10:287–333.10.1016/j.ejpain.2005.06.009Search in Google Scholar PubMed

[12] Mackintosh C, Elson S. Chronic pain: clinical features, assessment and treatment. Nursing Standard 2008;23:48–56.10.7748/ns.23.5.48.s54Search in Google Scholar

[13] Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, Kvarstein G, Stubhaug A. Assessment of pain. Brit J Anaesth 2008;101: 17–24.10.1093/bja/aen103Search in Google Scholar

[14] Strand V, Khanna D. The impact of rheumatoid arthritis and treatment on patients’ lives. Clin Experim Rheumatol 2010;X:S32–40.Search in Google Scholar

[15] Manchikanti L, Boswell MV, Singh V, Derby R, Fellows B, Falco FJ, Datta S, Smith HS, Hirsch JA. Comprehensive review of neurophysiologic basis and diagnostic interventions in managing chronic spinal pain. Pain Physician 2009;12:E71–120.10.36076/ppj.2009/12/E121Search in Google Scholar

[16] Bremander AB, Holmstrom G, Bergman S. Depression and age as predictors of patient-reported outcome in a multidisciplinary rehabilitation programme for chronic musculoskeletal pain. Musculoskeletal Care 2011;9: 41–8.10.1002/msc.198Search in Google Scholar

[17] Mancini I, Bruera E. Constipation in advanced cancer patients. Sup Care Cancer 1998;6:356–64.10.1007/s005200050177Search in Google Scholar

[18] Reimer K, Hopp M, Zenz M, Maier C, Holzer P, Mikus G, Bosse B, Smith K, Buschmann-Kramm C, Leyendecker P. Meeting the challenges of opioid-induced constipation in chronic pain management—a novel approach. Pharmacology 2009;83:10–7.10.1159/000165778Search in Google Scholar

[19] Bell T, Annunziata K, Leslie JB. Opioid-induced constipation negatively impacts pain management, productivity, and health-related quality of life: findings from the National Health and Wellness Survey. J Opioid Manag 2009;5: 137–44.10.5055/jom.2009.0014Search in Google Scholar

[20] Kurz A, Sessler DI. Opioid-induced bowel dysfunction: pathophysiology and potential new therapies. Drugs 2003;63:649–71.10.2165/00003495-200363070-00003Search in Google Scholar

[21] Kaasa T, Romundstad L, Breivik H. New therapeutic principles for adverse effects on upper and lowergastro intestinal tract in patients treated with opioid analgesics. Scand J Pain 2009;1 (Suppl. 1):S12–7.10.1016/S1877-8860(09)70004-7Search in Google Scholar

[22] Apkarian AV, Hashmi JA, Baliki M. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011;152 (Suppl.):S49–64.10.1016/j.pain.2010.11.010Search in Google Scholar PubMed PubMed Central

Received: 2011-06-09
Revised: 2011-10-19
Accepted: 2011-11-08
Published Online: 2012-01-01
Published in Print: 2012-01-01

© 2011 Scandinavian Association for the Study of Pain

Scroll Up Arrow