Chronic Pain (CP) is recognized as a major public health problem, causing significant economic and social burden. This condition affects not only the patient (as an aesthetic and emotional problem) but also his family and social circle. The biopsychosocial model, considered essential to pain, is the framework for understanding how different diseases are related, through an assessment of aesthetic, intellectual and interpersonal factors. Thus, within these contexts, it has been shown that Chronic Pain is often related to other processes that in turn greatly affect pain.
Studies carried out in different places have shown that CP affects between 10%-30% of adults in Europe. Indeed, a recent survey showed a prevalence of 16.6% of this condition in the general population of Spain, with at least one person affected in every four households. The experience of pain affects various aspects of the patient’s life by negatively affecting their daily activities, physical and mental health, family and social relationships and workplace relationships.
Quality of life (QoL), mental and physical, is another measure of the negative effects of pain. Various studies in patients with fibromyalgia, rheumatoid arthritis or back pain have shown that these conditions often cause a marked deterioration in the patient’s quality of life. This is why pain is recognized as a determining factor in quality of life. Health-related quality of life (HRQoL) has different content for each individual. It is related to the symptoms of the disease, the functioning of the person, his psychological state as well as existential and spiritual issues.
The parameters of the quality of life seek at a specific time the difference between what the patient hopes and expects and his actual experience of the situation he is experiencing. Quality of life parameters are disease symptoms, satisfaction with treatment, functional ability, ability to work, emotional balance, coexistence within the family, future plans, sex life and social life.
Many studies that analyzed the effects of CP on the patient’s life pointed out the close relationship between it and reduced physical activity. In fact, the intensity, duration or localization of the pain has a decisive effect on the patient’s physical activity, reducing it to the point of disability, which in turn affects other aspects of daily life.In one study of people with chronic low back pain, the ability to perform daily activities was reduced in just over a third of people (31.7%), while elsewhere physical limitation was evident in 50% of cancer pain patients. In a European survey, most people with CP suffered from various limitations with the ability to perform vigorous physical exercise, walking, performing household tasks, participating in social events and maintaining an independent lifestyle being the most affected.
Similar results were observed in other studies of specific groups of patients, such as those suffering from fibromyalgia or those with generalized pain. In these cases, the limitations present are more severe, with patients having significant difficulty performing basic activities such as standing up or sitting down.
It should be noted that patients with CP (compared to pain-free individuals) do not perceive their level of activity, given that subjective and objective measurements of physical activity differ. This is interesting because if patients overestimate their activity level, they may consider it adequate, thus eliminating the motivation to change behavior to increase their activity. The intention and will to change is a decisive prognostic factor in behavioral interventions in relation to the theoretical models applied. This explains why making patients aware of their behaviors ensures the adoption of a healthier lifestyle, which makes them more active and reduces the disability caused by their pain.
Sleep disturbances occur frequently in patients with CP, and are often related to quality of life. Sleep disorders can affect stress levels and thus such disorders cause difficulties in the performance of simple tasks by patients and can even affect their cognitive ability, respectively affecting daily tasks at work and at home. The correct diagnosis of sleep disorders and their adequate treatment are important in the management-treatment of patients with CP, and may be a way to improve the quality of life of patients.
The impact of pain on the work environment is an important factor to consider in patients with CP. Studies from different countries have shown that patients with pain experience problems with absenteeism from work. Not only do they need to change their tasks or position, but they may eventually lose their jobs as a result of the pain symptoms.
The helplessness caused by pain and the dependence it often brings can take its toll on family and friends. In a study it was observed that a large percentage of relatives of CP patients suffered from anxiety and sadness and had stopped participating in social events due to the existence of pain in the family. A loved one’s suffering from pain is described elsewhere as an overwhelming experience for family members who care for them, and often patients’ pain or distress is felt indirectly, transformed, fantasized, or distorted by caregivers who see it as worse than it is in fact.
In general, the existence of pain has a negative effect on the family environment, something that is perceived more strongly by relatives than by the patient himself, especially by those members who take care of them. Both patients and their relatives recognize that the greatest impact on the family from the existence of pain is the feeling of sadness, emotional changes, limitation of recreational activities along with sleep disturbances.
The need for a global and multidisciplinary approach to improve the patient’s condition and surrounding conditions, applying both pharmacological and non-pharmacological interventions, is evident. To achieve this goal, the social factors affecting patients with pain should be investigated.
The results of the assessment of the impact of pain on patients’ daily activities and their effects on family or work, such as those mentioned above, should be taken into account as means of improving the quality of life of the patient and his family.
