Does Chronic Pain Affect Life Expectancy?
Unfortunately, many studies do show that chronic pain can reduce life expectancy. A study from the European Journal of Pain found that: “Severe chronic pain was associated with increased 10 year mortality”.
Another study with a 17 year follow-up on mortality in women with musculoskeletal pain found that in those with: “chronic regional pain and chronic widespread pain, the mortality rate was respectively 4% and 8%”.
A 2018 study on back pain in women over the age of 65 found that over a period of 14.1 years of those who died: “A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%)”
Interestingly, it seems that people with more severe pain are more likely to have a reduced lifespan. This study from Arthritis Care and Research found that: “the highest proportion of deaths occurred for those reporting only 1–3 sites of pain but extreme pain interference (37.5%)”. This means that it’s the severity of the pain rather than how widespread it is that has the most significant impact on life expectancy.
However, there have also been studies that suggest that chronic pain doesn’t increase the likelihood of death. For example, one study on migraines and mortality concluded: “there was no evidence for a higher all-cause mortality or cardiovascular mortality among individuals with migraine.”
Likewise, another study concluded there was no evidence for a higher mortality rate among individuals with chronic musculoskeletal conditions.
A review of 10 studies on the topic concluded that there is a: “modest relationship between chronic pain and increased mortality but this is not significant.”
So although there is some evidence that chronic pain can reduce life expectancy, results are mixed and more research is needed. In studies where life expectancy was reduced, it depended on many factors including lifestyle, pain severity, additional health issues, socioeconomic status, access to treatment, and more.
How Can Chronic Pain Affect Life Expectancy?
We’ve established that chronic pain may be able to affect life expectancy, but how and why? Scientists don’t have a definitive answer at this stage, but there are a lot of factors that could be involved.
Increased Stress Levels
Living with chronic pain is stressful, but stress can also exacerbate pain. It’s a difficult stress and pain cycle that can seem impossible to break. It’s like we’re living in a near-constant state of fight or flight.
Living with such high levels of stress can have negative effects on the body. Increased stress levels can lead to high blood pressure, heart issues, a low immune system, digestive issues, lower bone density, widespread inflammation, and much more. Some of these issues can affect your life expectancy.
Thomas J. Romano, MD, PhD who specialises in rheumatology and pain management states that: “chronic pain is a significant source of stress and stress can cause problems with a patient’s immune system which, in turn, may lead to increased risks of infection, cancer, and other medical problems.”
It’s emotionally draining to be in pain all the time. It can affect your relationships, impact your ability to work, and stop you from doing things that you enjoy. So, it’s easy to see how chronic pain can lead to a decline in mental health.
I personally have experienced worse anxiety and periods of depression at times when my chronic conditions were in a flare-up. Similarly, my mental health tends to be easier to manage when my physical symptoms are reduced.
Unfortunately, your perception of pain and fear around it can actually worsen pain levels and other symptoms. It also appears to be able to affect life expectancy with one study finding that feeling anxious, frightened, or nervous was associated with an increase in death in chronic pain patients.
Research shows that chronic pain physically changes the brain and how it works. This 2019 study explains that this happens particularly in: “corticolimbic brain regions such as the prefrontal cortex, ACC, amygdala, hippocampus, NAc, and PAC.” The study goes on to explain that these changes can impact how our emotions work, leading to depression, anxiety, anger, and other negative feelings.
Living with chronic pain and mental illness can lead to suicidal thoughts, especially when you feel there’s no hope for improvement. Sadly, many chronic pain patients die by suicide.
One study evaluated suicides between 1 January 2003 to 31 December 2014 across 18 states in the USA. They found that of 123,181 suicides, a huge 10,789 (8.8%) had evidence of chronic pain.
If you are struggling with suicidal thoughts, please reach out for help. Contact emergency services, a mental health helpline, your doctor, or a loved one. You aren’t alone, and you can get through this!
When you’re in pain, it can be tough to exercise. You might worry that you are harming your body by doing so or find that moving your body worsens your pain (or other symptoms). So, many pain patients stop exercising in an effort to protect themselves and reduce their pain.
Unfortunately, over time this results in deconditioning. This means that your muscles become weaker because they aren’t being used. This can become a vicious cycle of worsening pain and reduced mobility.
Research has shown that premature death in chronic pain patients may be related to low levels of physical activity and a poor diet.
Issues With Eating Well
When you’re in pain as well as experiencing debilitating fatigue or other symptoms, it can be hard to shop for food as well as plan and cook healthy meals. Sometimes, it’s all we can do just to eat at all!
Of course, we know that our body needs a healthy diet as fuel to function. So, when we’re not getting the nutrition we need, our body suffers as a result. This can lead to malnutrition, weakness, and other health issues.
It’s hard to sleep when you’re in pain – enter the not-so-fondly named ‘painsomnia’! Lack of sleep is common in people with chronic pain.
Our bodies need sleep to function, repair, and re-energize. When we don’t get enough sleep it can result in worsened fatigue, issues with functioning, and additional health issues.
A study from Nature and Science of Sleep explains that long-term effects of poor sleep can include: “hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer.” These can have a knock-on effect, with these health issues causing reduced lifespan.
Most chronic illnesses have additional symptoms aside from pain, which can lead to other complications. Many chronically ill people will have comorbid conditions (meaning more than one diagnosis).
People with chronic pain are more likely to struggle with hypertension (high blood pressure), heart disease, respiratory issues, endocrine (hormonal) conditions, and more. These additional problems can have a detrimental impact on quality of life as well as lifespan.
One study found that chronic pain: “is associated with increased risk of death, particularly from heart disease and respiratory disease.”
A detailed study on mortality and chronic pain found a: “20% and 30% increased risk of dying over the follow-up period among subjects with regional and widespread pain, respectively.” The causes of death were cancer and cardiovascular disease.
Medication Side Effects
Sometimes the medication we take to manage our symptoms can have side effects that impact our lifespan. It’s all about weighing up the benefits of the medication versus the risks and side effects.
Opioids in particular are a risky medication to take, but for some people, it’s necessary for their quality of life. Long-term use of opioids can have multiple risks including addiction/dependence and accidental overdose. This detailed review explains that risks include: “serious fractures, breathing problems during sleep, hyperalgesia, immunosuppression, chronic constipation, bowel obstruction, myocardial infarction, and tooth decay.”
Lack of Access to Treatment
There’s still a lot of misinformation and stigma around chronic pain, even from medical professionals. I’m pretty sure that as a community we’re all used to doctors dismissing our symptoms or telling us to ‘just try harder’. It’s disheartening, infuriating, and can leave you feeling hopeless.
Without effective treatment, we’re left alone to try and manage, often feeling isolated with a low quality of life. Like any other untreated condition, our symptoms get worse, and over time, it may impact our lifespan.
It’s incredibly frustrating because there are effective treatments out there that can reduce pain levels and other symptoms, and help us improve our quality of life!
An article on access to treatment as a human right explains that barriers to effective pain treatment include: “poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment.”
What Can We Do About It?
This all sounds really depressing and worrying, but don’t panic! Thankfully, scientists are constantly working to better understand chronic pain and systems are gradually being put in place to improve chronic pain treatment.
As well as hoping for further advances in treatment, there are some things we can do about it as individuals.
Despite what some doctors might have told you, you don’t just have to ‘get on with it’ on your own! There are lots of treatments that you may be able to try.
- Talking therapies like cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT)
- Graded therapies like graded motor imagery (GMI)
- Creative therapies such as dance therapy and art therapy
- Massage therapy
- Pain clinics and pain management programmes (such as Pathways Pain Relief)
- Occupational therapy to help make day-to-day life more manageable
- Medications such as painkillers, antidepressants, and anticonvulsants.
- Over-the-counter remedies like topical pain relief
- Support groups to help you feel less isolated
These are just a few of the available options, so there’s bound to be something you can try!
Advocate for Ourselves
I know we shouldn’t have to, but as things stand in the medical field many of us will need to advocate for ourselves to get the treatment we need.
You can do that by:
- Keeping notes of your symptoms, appointments, and what doctors say
- Asking for copies of reports and test results
- Doing plenty of research so you’re well-informed
- Asking about treatments that you think might be useful for you
- Continuing to push for treatment
- Asking to speak to someone in charge or making a complaint if you feel you are being mistreated
If you struggle to advocate for yourself, there’s no shame in taking a loved one with you to medical appointments. Some chronic illness charities can help with advocacy and support during doctors’ appointments.
Take Care of Ourselves
Finally, we can help ourselves by taking the best care of ourselves that we can. Keeping up with daily tasks when you live with chronic pain can be tough and it’s ok to ask for help if it’s available.
We can take care of ourselves by:
- Trying to eat regular, healthy meals
- Doing exercise when we can
- Doing our best to sleep on a regular schedule
- Pacing our activity
- Keeping up with treatments and appointments
- Using mobility devices if we need them (there is no shame in using mobility aids, no matter what your age)
- Doing things that bring us joy
- Talking about our feelings
- Learning about our conditions so we’re better informed
- Finding community online or in person with other people like us
- Asking for help when we need it
Remember to be kind to yourself – if you’re doing your best, it’s more than good enough. You are not failing and you are not a burden!
- Nicola Torrance, Alison M Elliott, Aj Lee, Blair H Smith, (2009), “Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study”. European journal of pain (London, England) 14(4):380-6.
- Nitter, Anne K. and Forseth, Karin Ø, (2013), “Mortality rate and causes of death in women with self-reported musculoskeletal pain: Results from a 17-year follow-up study” Scandinavian Journal of Pain, vol. 4, no. 2, 2013, pp. 86-92.
- Roseen, E.J., LaValley, M.P., Li, S. et al. (2019), “Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.” J GEN INTERN MED 34, 90–97.
- Diane Smith, Ross Wilkie, Peter Croft, John McBeth, (2017), “Pain and Mortality in Older Adults: The Influence of Pain Phenotype”. Arthritis Care and Research, Volume 70, Issue 2, February 2018, Pages 236-243.
- Åsberg AN, Stovner LJ, Zwart JA, Winsvold BS, Heuch I, Hagen K., (2016), “Migraine as a predictor of mortality: The HUNT study.” Cephalalgia. 2016 Apr;36(4):351-7.
- Åsberg AN, Stovner LJ, Zwart JA, Winsvold BS, Heuch I, Hagen K., (2016), “Chronic musculoskeletal complaints as a predictor of mortality-The HUNT study.” Pain. 2016 Jul;157(7):1443-1447.
- Smith D, Wilkie R, Uthman O, Jordan JL, McBeth J., (2014), “Chronic pain and mortality: a systematic review.” PLoS One. 2014 Jun 5;9(6):e99048.
- Romano T., (2007), “Chronic Persistent Pain Can Kill.” Pract Pain Manag.;7(7).
- Yang S, Chang MC. (2019), “Chronic Pain: Structural and Functional Changes in Brain Structures and Associated Negative Affective States.” International Journal of Molecular Sciences; 20(13):3130.
- Petrosky E, Harpaz R, Fowler KA, Bohm MK, Helmick CG, Yuan K, Betz CJ., (2018), “Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System.” Ann Intern Med. 2018 Oct 2;169(7):448-455.
- Macfarlane, Gary J, (2016), “The epidemiology of chronic pain”. PAIN 157(10):p 2158-2159, October 2016.
- Medic G, Wille M, Hemels ME, (2017), “Short- and long-term health consequences of sleep disruption.” Nat Sci Sleep. 2017 May 19;9:151-161.
- McBeth J, Symmons DP, Silman AJ, Allison T, Webb R, Brammah T, Macfarlane GJ., (2009), “Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality.” Rheumatology (Oxford). 2009 Jan;48(1):74-7.
- Von Korff M, Kolodny A, Deyo RA, Chou R., (2011), “Long-term opioid therapy reconsidered.” Ann Intern Med. 2011 Sep 6;155(5):325-8.
- Lohman, D., Schleifer, R. & Amon, J.J., (2010), “Access to pain treatment as a human right.” BMC Med 8, 8.