Correcting the Record – The prevalence of chronic primary pain vs chronic secondary pain
The idea that most chronic pain has no physical cause is a myth. A lie told by people with a vested interest in treatments and interventions and courses and seminars and webinars and of course books,
These people, who developed interventions like Explain Pain, Pain Neuroscience Education, Pain Reprocessing Therapy and Pain Science Education, keep repeating the lie that most ‘chronic pain’ has no physical cause, because this is how they sell their wares.
The truth is, no one knows the prevalence of chronic primary pain vs chronic secondary pain. There is no evidence, the research hasn’t been done.
So they just make it up.
And, once again, no one checks. The people at these seminars and webinars and reading these books, just believe whatever they are told.
And they change their practices, without ever checking for evidence.
I went a googling for the prevalence of chronic primary and secondary pain. And found only two studies. One from England, which says the prevalence of chronic primary pain is unknown but estimated to be between 1% and 6%
https://www.ncbi.nlm.nih.gov/books/NBK569960/
Between 1 and 6%! That is a very small number for chronic primary pain. Hardly ‘most’ people. However, its one small study from England. Not exactly the final word.
Then I found another study that finds that 63% of chronic pain is primary pain.
That’s a huge difference. But, if accurate, it still finds that one third of people have chronic secondary pain. That’s still a large minority.
Of course this is a relatively small study too – 551 participants.
Then there’s Loerimer Moseley, who said on his podcast recently that people who have pain due to a hypersensitive pain system – his term for chronic primary pain – are about one in seven. One SEVENTH of people with chronic pain have primary pain. About 14%.
I don’t know where he was pulling that information from, he always talks about overwhelming evidence but never provides a link to it. But its interesting that Moseley himself is now admitting that chronic primary pain is the minority of chronic pain patients.
Then there’s the Deloitte report on The Cost of Pain from 2018.
This figure breaks down the causes of chronic pain in Australia, back in 2018
Interesting to note is that 38% of chronic pain is caused by injury.
Cancer, musculoskeletal, gastrointestinal, neurological, Infection, circulatory (cardiovascular), genitourinary, endocrine/hormonal and respiratory make up a further 29.5%, with the vast majority of that being musculoskeletal at 24.1%
This means that chronic secondary pain makes up 67.5% of all chronic pain.
That leaves the primary causes of chronic pain, being ‘mental health /behavioural’ and ‘no known cause / unknown’ at 32.5%. Mental Health is only 1.1% and no known cause is the second largest cause of chronic pain over all at 31.4%
But again, this report finds that about two thirds of people have chronic SECONDARY pain. That’s a pretty convincing majority.
All of these results are conflicting, but most lean towards at least 2/3 of people having chronic secondary pain. That is, pain where there is pathology causing the pain. I admit, this leans into my personal biases, and that’s still a guesstimate.
I also did searches on nociplastic and nociceptive and neuropathic pain prevalence. And I found some studies on individual diseases, like RA and MS comparing types of pain. Frankly, the numbers are all over the place.
The truth is no one has any flipping idea of the prevalence of primary vs secondary pain. No one has done any definitive research.
So why are we constantly told that most chronic pian has no known cause?
Its not true.
It’s a made-up statistic.
It’s a marketing ploy, a line.
Like so many things related to ‘chronic pain’
A myth that has been turned into ‘fact’, due to various thought leaders repeating it over and over and OVER again.
Its simple strategy and it works alarmingly well.
Because NO ONE bothers to check.
But it is NOT true. There is no evidence to support that statement.
Who benefits?
Two groups.
People selling Explain Pain and Pain Science Education type interventions for chronic pain. They only ever discuss chronic primary pain and they use the phrase ‘chronic pain’ to mean chronic primary pain. This benefits them, because it implies that all chronic pain can be treated with their pet intervention. Be it pain science education or pain reprocessing therapy, or some entrepreneurial physiotherapists own proprietary online program. Honestly, some of these people aren’t even aware of chronic secondary pain. They have only learned half the story. They don’t even know what they don’t know. But they frame themselves as an expert.
And the anti-opioid brigade. This is a lie that has been told to deny people access to safe and effective pain medications. Opioids are not effective for chronic PRIMARY pain. Opioids should NOT be prescribed for chronic PRIMARY pain. But.
Opioids ARE safe or most people, addiction and overdose are vanishingly rare in the chronic pain community, and sometimes opioids are the ONLY effective treatment for severe chronic secondary pain.
But this myth about the prevalence of chronic primary pain/nociplastic pain denies people access to effective pain medications.
Who is harmed?
People who live with severe, pathological pain from injury and disease.
This myth that most chronic pain is NOT caused by pathology, has caused a great deal of harm to people who live with chronic secondary pain.
People who live with chronic secondary pain are only offered treatments that address the psychosocial aspect of their pain, while ignoring the root cause – the bio.
Obviously, the biological causes of pain ALSO need to be addressed, otherwise the pain will remain.
Treatments for primary pain CANNOT cure chronic secondary pain.
But as long as this myth is prevalent, people living with chronic secondary pain will continue to be ignored. Their pain left untreated or undertreated.
So please. Stop repeating the myth that most chronic pain has no physical cause. It’s not true. And it’s the cause of a LOT of harm for people who live with chronic secondary pain.
Neen I’m one of those people who think the level of chronic primary pain is a massive proportion, and I extrapolated that data from the most recent Deloitte report on chronic pain in Australia using a chart which categorised types into segments such as “psychological” (quite small by the way), and back pain persisting long after injury. It seemed to match up with with other data from other organisations, and handily at the time matched my experience in the pain clinic in terms of response to treatment (I only worked with chronic primary pain, having no expertise in chronic pain with sufficient explanatory pathology).
The Pain/Addiction fight is reminiscent of Europe's reaction to what we now call PTSD: A mental disorder in which the person remembers a repressed memory of trauma and reacts emotionally as if he is right back in his foxhole watching his two buddies become a cloud of pink fog, just before the fragment from the shell that killed them, shattered his left wrist.
Europeans called it Shell Shock.
The proximate cause is war itself.
But seeking abstruse explanations for it, for military families, became a diversion.
Freud wrote books and articles theorizing about how excessive maternal affectjon caused homosexual tendencies which in turn led to shell shock.
The proof? None was ever found.