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There is little recent research performed in the UK regarding the public attitude toward pain, therefore the initial studies presented here refer to North American populations, followed by European studies. Often population studies focus either on cancer pain or chronic pain as pain models, to ensure homogeneity of findings. In terms of population studies, either can show how the public think about pain.

Public beliefs about cancer pain were investigated by telephone survey (Levin et al. 1985). Results showed the public in Wisconsin thought the

be painful (48%). When asked to rate their concerns about the use of opioids for the relief of pain, the majority of participants were very anxious about side effects of taking these drugs, mainly addiction and mental confusion.

The Mayday Fund survey (Bostrom 1997) found 92% of respondents agreed pain was a part of life (41% strongly agree) and that people were more concerned with the meaning of pain, than the pain itself, with 88% agreeing that it is more important to treat the cause of the pain than the pain. When asked how they responded to their last episode of moderate to severe pain, only 30% said they acted quickly to relieve the pain, with 71% of participants generally avoided calling the doctor if they are in pain. Participants were afraid of becoming addicted or dependent on analgesics, with 82% agreeing that it is easy to become reliant on medication. The idea that if one took too much pain medication now, it would not be effective when you really needed it, was agreed by 72% of participants (Bostrom 1997). A commentary on this study cited addiction as ‘the ultimate loss of control’ and suggested this was

the reason so many of the public were reluctant to use opioids; even a vanishingly small chance of this loss of control occurring caused a barrier to receiving adequate analgesia (Fins 1997 p. 171). McCaffery and Ferrell (1996) suggests society’s view around illicit drug taking, at the time strap lined by ‘just say no’’, promoted misinterpretation of the role of analgesic medications among the public.

These results have been replicated many times; pain is a normal part of peoples’ medical conditions and they just have to live with it, people were

uncomfortable talking about pain, they are worried about addiction, and good patients do not complain about pain (Allcock & Toft 2003, American Pain Foundation 2008, Cosby et al. 2005).

Although there has been a range of North American surveys investigating what the public think about pain, with similar results, there are further studies from the UK. Scott and Hodson (1997) investigated public perceptions of postoperative pain by having people who were attending their General Practitioner (GP) complete a short questionnaire (n=519). Most people (82%) agreed pain after major surgery would be unbearable and should be dealt with immediately. However there were less expected results shown; 17% of respondents felt they should be able to get by without strong

painkillers, and nearly half of the participants agreed with the statement, ‘you should put up with a bit of pain rather than complain’. The authors

concluded the general population of the UK did not have very much

understanding of postoperative pain, or of the methods used to treat it. The public were shown to have a great deal of confidence in the medical and nursing staff to treat pain, with 85% of participants believing hospitals were good at treating postoperative pain (Scott & Hodson 1997).

A small qualitative study using semi-structured interviews demonstrated how patients at a London pain management clinic viewed pain and the affect it had on their lives; their pain careers (Bendelow & Williams 1996). This study divided patients into two groups. A ‘resignation’ group with those people who felt their lives were wholly dominated by their pain, and an

themselves from their pain. In this study the resignation group was the larger, they were the patients receiving the more medically focused pain management treatments, and had the poorer outcomes. The paper discusses the participants’ view that their pain should be treated as ‘real’ pain, rather than dismissed as not treatable, and concludes with a

suggestion for more research to examine the significance of patients ‘pain careers’.

A very large study primarily investigating the prevalence and burden of chronic pain in Europe received 46,394 responses from sixteen countries around Europe (Breivik et al. 2006). The prevalence data has been

discussed earlier, however participants were also questioned about their beliefs and attitudes to pain. Many of them (63%) were concerned about medication side effects with over a third (38%) worried they would become addicted to the medications. Three statements about medication beliefs and attitudes, ‘I would rather take medications for my illness than my pain’ (55%), ‘my pain is not severe enough to take pain medicine’ (25%), and ‘I am taking so many medicines, I do not want to take pain medicine too’ (23%), could be consistent with the finding reported by Cosby et al. (2005), ‘pain is just a

normal part of life’.

This section has briefly reviewed studies which examine how the public view pain. The public are experiencing pain, and on many occasions it is poorly treated (Breivik et al. 2006). There is some evidence that demonstrates the

public appear reluctant to complain about pain, they are uncomfortable talking about it. They are unwilling to take painkillers for a number of

reasons, but many studies cite fear of addiction as a significant factor. In contrast, if patients are experiencing daily pain it seems pain can become very important, and completely dominate patients’ lives to the exclusion of all else (Bendelow & Williams 1996). This disparity presents a complex picture of the public perception of pain.

This thesis focuses on pain in hospital, so the next section will investigate in more depth what patient factors influence pain management while they are inpatients.