Philippine Journal of Internal Medicine

Original Article

Prevalence and Treatment of Chronic Pain in the Philippines

Henry Lu, M.D.* and Francis Javier, M.D.**

source: http://www.net-head.net/~pcporg/images/stories/pjim_49/issue2_apr-jun2011/02
Prevalence_and_treatment_of_chronic_pain_in_the_Phils.pdf

Abstract
Background: There are currently no data on the
prevalence and incidence of chronic pain in the
Philippines.
Objective: This study was undertaken to determine
the incidence and prevalence of chronic pain in
the general adult population of the Philippines. It
also aimed to establish the demographic profile
of chronic pain sufferers, identify the causes and
intensity of chronic pain, and understand the
impact of chronic pain on daily living and quality
of life. This study also explored current treatment
practices for patients with chronic pain, their
levels of satisfaction with treatment, and barriers
to obtaining appropriate treatment.
Methodology: The study was conducted in the
Philippines via a quantitative sample survey that
involved face-to-face interviews using a two-phase
structured questionnaire.

pain
M+S
was
more
commonly
reported
by
women
and
the
elderly.
The
most
common
locations of pain were the knees, back and lower
back. Daily routine was affected in about half
of the sufferers, but they had rational attitudes
to pain and positive views of medical treatment.
High consultation fees discouraged nearly twothirds of sufferers from seeking medical advice
for their pain. Despite the availability of effective
pain treatments, a large proportion of patients
taking prescription painkillers reported that the
medication was less than effective, indicating a
large gap between achievable pain relief targets
and patients expectations of pain medications.
Conclusion: The Philippines has a relatively high
prevalence of chronic pain M+S. There is a need
for improved pain management to ensure that
patients with chronic pain receive appropriate
and effective treatment.

Results: The survey showed an overall prevalence

of moderate-to-severe chronic pain (chronic pain
M+S) of 10.4% of the general adult population,
with an annual incidence rate of 3.4%. Chronic

Keywords:
prevalence,
treatment.

I ntroduction

of persistent pain among primary care patients

showed that the prevalence of chronic pain in a
primary care setting is at least as prevalent in
developing countries as in developed ones. 5

Studies
on
chronic
pain
in
the
Western
world have argued that it is not only a physical
problem but also in many respects a social
issue. 1012 Chronic pain has been considered as
a biopsychosocial phenomenon; that is, aside
from being an indication of the bodys biological
state, cultural and social factors may also affect
the expression and management of pain. Different
societies may have their own perception and
treatment of pain; 13 understanding this aspect can
guide clinicians in delivering appropriate care.

Data on chronic pain are usually gathered
by diagnostic categories (e.g. arthritis), and from
symptoms presented to doctors, or other sources
such
as
disability
or
insurance
reports. 14
Both
under-expression and under-diagnosis of pain are
common, meaning that a large proportion of

The International Association for the Study of
Pain (IASP) defines pain as an unpleasant sensory
and emotional experience arising from actual or
potential tissue damage or described in terms of
such damage. Chronic pain, especially of the
moderate-to-severe
type,
diminishes
a
persons
quality of life, causes loss of work productivity, 1,2
and may be associated with anxiety or depressive
disorder. 3

Chronic pain of moderate-to-severe intensity
affects many people, but epidemiological studies
have been limited to Western countries and a
few Asian countries. 49 A World Health Organization
(WHO) study assessing the prevalence and impact
*Head, Pain Control Clinic, Makati Medical Center; Head, Pain
Management Center, St. Lukes Medical Center, Global City

**Director, Pain Management Center, Quezon City

Asia,
chronic
pain,
quantitative survey, the

incidence,
Philippines,

Volume 49 Number 2 Apr.-Jun., 2011

61

Lu H, et al

Prevalence and Treatment of Chronic Pain in the Philippines

M aterials

patients tolerate living with pain and accept it

as part of their lives, without taking adequate
treatment. 4

International treatment guidelines recommend
a stepwise approach to the treatment of chronic
non-cancer
pain,
involving
not
only
over-thecounter
(OTC)
medication
and/or
non-steroidal
anti-inflammatory drugs (NSAIDs) but also lowerdose opioids. 15,16 In developing countries, effective
pain management is often hampered by underavailability of effective pain relief medications.
Analgesics such as NSAIDs and paracetamol are
often used as first-line treatment for all types of
pain, as they are believed to be relatively safe,
thus preventing the use of stronger pain relievers.

The present quantitative survey was conducted
not only to estimate the prevalence and incidence
of chronic pain in the general adult population
of the Philippines but also to identify the sufferers
perceived and stated causes of chronic pain
and to quantify current treatment. The results of
this study will help develop an understanding of
the impact of chronic pain on economic factors,
quality of life, and daily living, based on the
rationale that exploring the attitudes of sufferers
towards pain and their experiences of pain is
required for understanding the sufferers behavior.

and Methods

Questionnaire

Using
a
two-part
structured
questionnaire,
a
quantitative
sample
survey
was
conducted
in
urban
and
rural
areas
of
the
Philippines.
The questionnaire, previously used to study the
prevalence
of
chronic
pain
in
16
European
countries and in Japan, 4,7 had been validated for
use in the Philippines.
Screening and detailed interviews

Face-to-face
interviews
were
carried
out
between February and March 2006 among adults
aged 1885 years. Listing interviews were conducted
to screen the respondents and to estimate the
prevalence and incidence of chronic pain in the
sample population. In this study, incidence was
defined as the annual rate of new cases or those
suffering from chronic pain in the last one year.

Respondents were considered to be suffering
from
chronic
pain
if:
(1)
they
had
suffered
from pain in the last six months; (2) they had
pain for more than three months; (3) they had
experienced pain in the last month; (4) they
had pain frequency of several times a week or
more (chronic pain sufferers); and (5) their pain
measured four or more on the 10-point pain
scale
(moderate-to-severe
chronic
pain
sufferers
[chronic pain M+S]). Respondents who fulfilled these
criteria were interviewed further, using a detailed
questionnaire.
The
detailed
questionnaire
was
designed to assess current attitudes, beliefs and
practices with respect to pain.

O bjective

This study was undertaken to determine the
incidence and prevalence of chronic pain in the
general adult population of the Philippines. It
also aimed to establish the demographic profile
of chronic pain sufferers, identify the causes and
intensity of chronic pain, and understand the
impact of chronic pain on daily living and quality
of life. This study also explored current treatment
practices for patients with chronic pain, their
levels of satisfaction with treatment, and barriers
to obtaining appropriate treatment.

Sampling

To ensure proper representation of the overall
adult population, multi-stage, stratification random
sampling was conducted across five regions of
the Philippines, namely Greater Manila, north and
central Luzon, south Luzon, Visayas, and Mindanao.
The Kish grid was used to select members within

Table I. Interview Coverage In The Philippines

Urban
Region

62

Listing

Detailed

Rural
Listing

Detailed

Total
Listing

Detailed

Greater Manila area

3,000

300

3,000

300

North and Central Luzon area

1,000

100

1,000

100

2,000

200

South Luzon area

1,000

100

1,000

100

2,000

200

Visayas

1,000

100

1,000

100

2,000

200

Mindanao

1,000

100

1,000

100

2,000

200

Total

7,000

700

4,000

400

11,000

1,100

Volume 49 Number 2 Apr.-Jun., 2011

Prevalence and Treatment of Chronic Pain in the Philippines

Lu H, et al

a household to be interviewed. The distribution of

respondents in each area is listed in Table I.

data were weighted by gender, age, and socioeconomic classes (SEC). SECs were classified on the
basis of home ownership, educational attainment,
occupation
of
household
head,
and
monthly
household income, such that SEC A/B (> 100,001
pesos), SEC C (30,001100,000 pesos), SEC D (7,001
30,000 pesos) and SEC E (< 7,000 pesos).

Quality control

To enhance the accuracy of representation
of the population of interest from the achieved
sample, data were weighted using the multilevel rim weighting technique. Urban and rural

35

Chronic pain sufferers

30

Chronic pain sufferers (M+S)

25
20
15
10
5
0

Universe: (43.5)
(in millions)

All

(21.7)

(21.8)

(22.8)

(12.2)

Men

Women

18 - 35

36 - 50

(8.4)

(3.8)

(29.8)

(10.0)

(21.3)

(22.2)

50 +

ABC

Urban

Rural

Y-axis label: Categorisation of chronic pain sufferers and chronic pain sufferers (M+S)

Figure 1. Prevalence of Chronic Pain and Chronic Pain M+S sufferers

R esults
Screening results: prevalence and incidence of
chronic pain

The total study population of 11,000 interviewed

35

Chronic pain sufferers

Incidence of Chronic pain (%)

30

Chronic pain sufferers (M+S)

pain was higher in women than in men, and this

increased with age and marginally with affluence.
No difference was noted in pain prevalence
between urban and rural areas. The prevalence of
chronic M+S showed a similar pattern (Figure 1).

The study populations annual incidence rate
of chronic pain was 4.8%. For chronic pain M+S
sufferers, the annual incidence rate was 3.4%. The
reported average duration of suffering was 5 years
(Figure 2).

25
20
15
10
5
0

4.6

7-15

16-24

25-36

37-48

49-60

>60

Duration of suffering from pain (months)

Figure 2. Incidence of chronic pain and chronic pain M+S

in the listing interviews was weighted to represent
43.5 million, which was the total population of
the Philippines aged 1885 years in 2006. Of this
population, 5.9 million (13.6%) suffered from chronic
pain, and for 4.5 million (10.4%) the chronic pain
was chronic pain M+S. The prevalence of chronic

Results of detailed interviews

Profile of chronic pain M+S sufferers and their
pain

The majority of the chronic pain M+S sufferers
were women (57% versus 43% of men). Those >
50 years old seemed to suffer more, as 50% of
the total chronic pain M+S sufferers were from this
age group, even though it represented only 20%
of the total sample population. A total of 89% of
chronic pain M+S sufferers were from SEC D and
E.

Overall, pain was most commonly reported
in the knee (31%), back (unspecified; 22%), lower
back (21%), hip (19%), and leg (18%). Gender
differences in pain location revealed that men
reported to suffer more pain in the knee (32%),
lower back (26%), and leg (22%), while women

Volume 49 Number 2 Apr.-Jun., 2011

63

Prevalence and Treatment of Chronic Pain in the Philippines

Lu H, et al

Chronic pain M+S sufferers (%)

45

18 - 35

40

36 - 50

35

50+

30
25
20
15
10
5
0

Knee

Back
(unspecified)

Lowback

Hip

Leg

Head

Location of pain

Figure 3. Location of pain by age group

suffered more pain in the back (23%), hip (21%),

and
head
(21%).
Figure
3
shows
the
mostly
commonly reported locations of pain by age
group. Chronic pain M+S sufferers in the 1835-years
age group complained mostly of pain in the
head, low back, and back (unspecified); those in
the 3650-years age group complained of back
(unspecified), knee, and low back pain.

100% 5

12

13

10 12
21
13 17
14

15

12

2210

12

14

2
3
22

11

8
20
11

11

12

16

14
16

20%

51

49

12

25

51 50

9
8

10

ra

15 14

15

10 The worst pain

imaginable

Ru

36

18

18

13

en

5
-5
0
50
+
AB
C

16 15

-3

14

W
om

15

Al

15

en

5
14 19

20

19

15

13

49
40% 51 45 55 55 47 51

0%

an

60%

6
6

Ur
b

80%

5
8

More than two-thirds of chronic pain M+S
sufferers
indicated
multiple
body
locations
as
sources or causes of pain. The probability of
suffering pain from multiple locations increased with
age. Chronic pain M+S sufferers from SECs D and E
reported a higher prevalence of multiple locations.

Arthritis
was
the
most
common
cause
of
chronic pain (43%) for both men and women, and

Chronic pain sufferers (M+S)

Figure 4: Intensity of pain felt by chronic pain sufferers

more distinctly in the > 50-years age group. Muscle

pain occurred in 14% of sufferers, chest pain in
11%, and headache in another 8%. Bone and joint
pain were more commonly reported by people
in the > 50-years age group, whereas chest pain
and headache were more common complaints of
people in the 1835-years age group.

64

Volume 49 Number 2 Apr.-Jun., 2011

When
asked
to
describe
the
pain
they
generally experienced, 81% of sufferers described
their pain as intermittent. Of the remaining 19%
who experienced constant pain,
men more than
women and people in the > 50-years age group
more than any other age group were found to be
constant pain sufferers. On a pain scale of 110,

Prevalence and Treatment of Chronic Pain in the Philippines

Lu H, et al
(13% versus 7%). People with very severe pain were
mostly from the > 50-years age group (11% versus
7% and 9% from the 1835-years and 3650-years
age groups, respectively), from the SEC D and E
(21% versus 5% from the SEC ABC), and from rural
areas (11% versus 9% from urban areas).

Very few of the chronic pain M+S sufferers
reported discussing their pain with their doctors
(2%). The majority of sufferers chose to talk about
their pain with their spouses or partners (57%),
followed by other family members (39%).

79% of chronic pain M+S sufferers rated their pain

between four and six (Figure 4). More than half of
the respondents (51%) gave their pain a score of
five (mean score of 5.8). Seventeen percent rated
their pain as severe, giving it a score of between
eight and 10 on the pain scale. In this group of
severe pain sufferers, there were more men than
women (21% versus 15%) and more people from
the 3650-years age group than the > 50-years age
group (22% versus 16%).

While the majority (56%) of the chronic pain
M+S sufferers could tolerate a little more pain,
10% suffered from such severe chronic pain that
they could not tolerate the pain at all. More men
than women reported their pain to be intolerable

Impact of pain on daily life

Chronic pain M+S affected 48% of sufferers to
such an extent that they were unable to carry
out daily routine work. These people had lost an

% of chronic pain M+S sufferers

33

60
50

39
31

30

26 25
25
16

20
10

40
17
21

30

22
14

12 12 12
12

9
13

12 10

se

10
0

Se

de
In

ca

20

in

6 7 4
5

xu

pe

Ex

nd

er

en

al
ci
So

ci

ce

e
iz

lif
y
jo

re

en

m
fa
of

ily

k
W
al

p
ee
Sl

in
th
ft
Li

8 8 5
7

Ta
k

Pe

rfo

rm

da

ily

ta

sk

gs

8
9

ity

48 52

tiv

40

70

62

56

ac

50 48

al

50

59
60

65

in

59

riv

61 63 62
62

60

70

Activities affected by chronic pain

18 - 35

36 - 50

50 +

All

Figure 5: Activities affected by chronic pain, as reported by chronic pain M+S sufferers

average of 11.4 days in the last 6 months, or 8%

of working days. The degree of the impact of pain
on daily life was higher in the lower SECs and in
the rural areas.

The degree of pain severity varies among
sufferers at different times of the day. For example,
33% of the chronic pain M+S sufferers reported that
their pain was worst in the evenings, while 27%
and 23% reported their pain to be worst in the
morning and afternoon, respectively. All sufferers
experienced the least pain during the night.

The top five activities reported to be affected
by pain were 1) performing daily tasks, 2) sleeping,
3) lifting things, 4) walking, and 5) taking care of
family. Figure 5 illustrates how chronic pain M+S
affects these activities by age group.

The attitude of chronic pain M+S sufferers
towards their pain was generally rational. They
associated their pain with a causal illness, rather

than attributing it to fate or misdeeds. Attitudes

towards medical treatment were also positive, as
the majority were willing to try new treatment
for pain and to pay for it if it was effective in
relieving their pain. The general perception of
health was positive among the chronic pain M+S
sufferers. The majority (77%) perceived their health
as fair or good; 16% considered themselves to
be in poor health; and 7%, despite complaints of
chronic pain M+S, saw themselves to be in very
good or excellent health. Perception of health
was poorer in men than women, with 19% of men
seeing themselves to be in poor health (versus 13%
of women). People of SEC D and E also reported
poorer perception of health than people of SEC
ABC, with a total of 34% of those in SEC D and E
considering themselves to be in poor health versus
seven percent of those in the SEC ABC.

Volume 49 Number 2 Apr.-Jun., 2011

65

Lu H, et al
Treatment profile and practices
This study showed that treatment for pain is
prevalent in the Philippines. Only 2.7% of the
chronic pain M+S sufferers (or 0.1 million people)
had never received treatment for their pain. They
believed that they could manage the pain on their
own and did not require treatment; they generally
disliked doctors, medicines and surgery, and they
did not believe that drugs could help in relieving
their pain.

Of the 4.4 million chronic pain M+S sufferers
who had ever received treatment to manage
their pain, 80.1% reported that they were currently
receiving treatment. More women than men (80%
versus 76%), and more people in the > 50-years
age group (81%) and in the upper SEC ABC
(86%), were receiving treatment. When sufferers
currently being treated were asked to describe
the treatments they were receiving, 62% (2.1
million) admitted to self-medication only; 30%
visited their doctors and self-medicated; and 9%
only visited their doctors.

The high rate of doctors fees was reported
by 48% of chronic pain M+S sufferers currently
receiving treatment as a main reason for not
consulting a doctor for their pain. Other reasons
given were that their pain had improved (20%),
they could manage their pain on their own
(19%), they preferred alternative methods (12%),
they disliked doctors in general (8%), and they
believed that exercise helped to relieve their pain
(3%).
Consultation for pain

Of the 1.4 million chronic pain M+S sufferers
who were currently being treated and were
visiting a doctor, 69% indicated that they had
consulted with a doctor for both their illness
and pain, rather than specifically for their pain
(13%). When asked to name the type of doctor
they visited for their pain, or illness associated
with pain, 62% of the sufferers said they had
visited a general practitioner, while 38% said they
had consulted with a specialist. The majority of
sufferers who consulted with specialists belonged
to the upper SEC ABC (61%).

When asked specifically whether they had
ever heard of pain management specialists, more
than two-thirds of the chronic pain M+S sufferers
said no. Of those who were aware of pain
specialists, only 17% had actually visited one.

The average duration that sufferers consulted
with their doctors was four months (15.8 weeks).
This duration was higher among pain sufferers
in the > 50-years age group (18.2 weeks) and
in the SEC ABC (18.3 weeks), as well as among

66

Volume 49 Number 2 Apr.-Jun., 2011

Prevalence and Treatment of Chronic Pain in the Philippines

those living in urban areas (17.9 weeks).

For those seeing their doctors for illness or
pain, X-rays (39%) and blood tests or sugar tests
(36%) were the most common tools used by
doctors for pain diagnosis. In 36% of these cases,
no investigation was undertaken. Absence of any
investigation for pain was more common among
the 1835-year age group.

When asked how the doctor determined how
much pain they were experiencing, 66% said that
they told the doctor themselves. Other common
methods for assessing a patients degree of pain
included the doctor touching the painful body
part (55%), moving the body part (13%), or asking
the patient to walk (7%). Only 4% of the sufferers
reported that their doctors used a pain scale,
whereas two percent said that their doctor did
not use any method at all.

Of those who consulted doctors for their
chronic pain M+S, 29% have been diagnosed
with depression and/or anxiety. This was especially
more widespread among the elderly and the
affluent, and more common among men and
those living in urban areas.

Seventeen
percent
of
chronic
pain
M+S
sufferers who had ever received treatment had
been hospitalized at some point due to their
pain. This is the same proportion of sufferers who
complained of severe pain. The reported average
stay in the hospital was seven days.

According
to
51%
of
chronic
pain
M+S
sufferers who had visited a doctor for their pain,
doctors attitudes towards pain were generally
optimistic, believing that pain could be controlled.
The comfort level in consulting doctors about
pain was high among sufferers, as the majority
of them (97%) felt comfortable discussing their
pain with their doctors. Overall, there was high
satisfaction
with
the
pain
advice
that
they
received from their doctors; only 5% were not
satisfied. A higher satisfaction rate was noted in
the more affluent SEC ABC group, as this was
the group more likely to consult with specialists
for their pain. The predominant reasons given
for being satisfied include the doctors ability to
relieve pain, show empathy, and keep the patient
informed of his or her condition (Figure 6).
Medical treatment for pain

Of the 4.4 million chronic pain M+S sufferers
who had ever received treatment, 4.2 million
(95.5%)
had
used
prescription
pain
relievers.
Of the 4.1 million (93.2%) who had used selfmedication, 3.5 million (85.4%) had used OTC
pain relievers and 2.4 million (58.5%) had used
alternative therapy. About 40% of the sufferers

Prevalence and Treatment of Chronic Pain in the Philippines

Lu H, et al

% of chronic pain M+S sufferers

70

60

59 57
53

60

50

50
40
30

42
32
28 30
25

30

20

19

40
29
25

29 30

28

26

18

28
25

22

19

27
24

30
17
13 14 16

17
13 14 16

10

18
10

20
12
13

20

12 9
11

1 4 2
2

0
Relieved my
pain

Shows
empathy

Keeps me
informed

Understanding
Shows me
how to
manage pain

Easy to talk

Affordable
fees

Knows my
medical
history

Good
experience

Do not give
unnecessary
medication

10
0

Tries different
treatments to
help

Factors enabling satisfaction with doctor

18 - 35

36 - 50

50 +

All

Figure 6: Factors enabling satisfaction with doctor, as reported by chronic pain M+S sufferers

100%
80%
60%

13

13

13

11

16

48 3.7 50 3.7

47 3.7

47 3.7

48

37

39

40

33

3.8

12

13

48 3.7

52

37

33

3.8

13

13

13

48 3.7

46 3.7

50

37

38

33

13
3.7

45 3.7

40%
20%

34

42

5
4
3
2
1

0%

All

Men

Women 18 - 35 36 - 50

50+

ABC

Urban Rural

Chronic pain sufferers who have ever taken prescription medicines

Not at all effective

Not effective

Somewhat effective

Very effective

Completely effective

Mean score (out of 5)

Figure 7: Perceived efficacy of prescription medications for pain

had used or were using prescription and OTC

pain relievers and alternative therapies.

The most common forms of prescription pain
relievers taken by the sufferers who had used
prescription medicines were oral (75%) and topical
(20%). When asked how they felt about the
efficacy of their current prescription drugs, 61%
felt that they were effective, whereas 39% felt
that they were somewhat or not effective (Figure
7). When sufferers who had seen a doctor for
the treatment of their pain were asked whether
they had switched medication, 40% said yes.

The majority (86%) of sufferers who had used
OTC pain relievers reported that their choice

of medication was based on the advice of

friends and relatives. As with prescription drugs,
about 67% were also aware of the specific
OTC medications they were taking currently, the
most common of which were the combination
of
paracetamol and ibuprofen (49%); mefenamic
acid (36%); paracetamol (26%); and ibuprofen
(10%). As to the efficacy of their current OTC
treatment, 48% felt that the medication was
effective, whereas 51% felt that the treatment
was somewhat or not effective.

Massage (unspecified) and hilot (the traditional
Philippine form of healing massage) were the most
commonly reported alternative forms of therapy

Volume 49 Number 2 Apr.-Jun., 2011

67

Lu H, et al
used to relieve pain, followed by herbal medicines
and exercise. When asked about the efficacy of
the alternative therapy they were using, 46% felt
that the therapy was effective, whereas 54% felt
that it was somewhat or not effective.

D iscussion

This large nationwide quantitative survey showed
that the Philippines has an overall prevalence
of 10.4% chronic pain M+S in the general adult
population, and an annual incidence rate of 3.4%.
Women rather than men, adults in the > 50-years
age group, and those in the lower SECs are more
likely to suffer from chronic pain. This profile of
chronic pain sufferers is consistent with existing
literature exploring the relationships between pain,
gender and the ageing process. 17,18

The daily routine of almost half of the
chronic pain sufferers is affected by their pain.
Common
physical
activities
such
as
lifting,
sleeping and walking are also affected by pain.
Chronic pain has financial implications for pain
sufferers as a result of individuals taking days
off work, and loss of productivity.

This study showed that Filipinos have rational
attitudes about their pain. They believe that
their pain is due to an underlying illness, and
do not consider their pain to be a result of
past misdeeds, nor do they accept it as their
fate. The general perception of their health is
positive, and many Filipinos are receptive to
trying new treatment, and willing to pay for
it if the treatment is efficacious. Interestingly,
the proportion of the adult population who
consider themselves to be in poor health is the
same group who rate their chronic pain to be
severe.

Although
chronic
noncancer
pain
is
not
listed among the leading causes of death and
disease burden worldwide, it does increase a
patients suffering and diminishes all aspects
of quality of life. 4 As chronic pain and the
physical
and
psychosocial
complications
associated with it form a major healthcare
concern,
pain
control
is
fundamental
to
Results
from
this
managing
the
disease. 4
study showed that the majority of all of pain
sufferers have at some point been treated for
their pain, but the number of those currently
receiving
treatment
is
lower
by
20%.
Also,
nearly two-thirds of pain sufferers are opting
for self-medication with OTC and alternative
therapies rather than for medical consultation.
It is not unexpected that affordability is the
main barrier to consulting a doctor, as a large

68

Volume 49 Number 2 Apr.-Jun., 2011

Prevalence and Treatment of Chronic Pain in the Philippines

majority of chronic pain M+S sufferers are in
the SEC D and E.

This finding supports an earlier study in the
Philippines by Manahan et al., which concluded
that only a quarter of those suffering from
rheumatic pain visited a doctor. 19 Chronic pain
sufferers
may
have
to
turn
to
government
hospitals
to
afford
treatment,
but
budgets
of these hospitals are mostly allotted to the
control of infectious diseases, and pain control
is a lesser priority. 20

Nevertheless, findings from the present study
showed that chronic pain sufferers who visited
a doctor for pain symptoms reported an overall
high degree of satisfaction with their medical
care based on the treatment efficacy, pain
relief, bedside manners, and information and/or
counselling they received. Sufferers in general
felt comfortable in discussing their pain with
their doctors and there was no reported stigma
or barrier associated with pain.

The
study
revealed
a
substantial
gap
between
the
treatments
received
and
the
patients expectations of pain relief. Physicians
who regularly treated pain patients thought
that strong analgesics were required for the
management of pain. The same study found
that
these
doctors
prescribed
opioids
for
noncancer pain and believed that opioids were
not reserved for the terminally ill. 4

Support for the use of opioids in managing
pain
of
non-malignant
origin
is
widespread,
especially in developed countries. 21 According
to the IASP, There is certainly credible [...]
evidence
that
a
subpopulation
of
patients
with
chronic
noncancer
pain
benefits
from
the use of opioids. 15 However, prescription of
effective pain relievers such as opioids in the
Philippines is limited. One possible explanation
is the concern of prescribing doctors and even
nurses administering the drug that the patient
with pain will become addicted to the drug. 20,22
Chronic pain sufferers also have a general fear
of drug addiction from opioids, and they would
rather give in to pain. 4,23

However, the present study showed that the
chronic pain sufferers are willing to try new
pain treatments, and neither addiction nor side
effects appear to be significant concerns. It
may be worthwhile for clinicians to examine the
clinical evidence and the benefits of opioids in
chronic noncancer pain. 21 A large proportion of
patients appreciate their doctors not only for
relieving their pain but also for providing them
with information about their treatment options.

Possible
limitation
of
this
study
is
the

Prevalence and Treatment of Chronic Pain in the Philippines

interviewer bias that
to-face interviews.

S ummary

may

be

inherent

Lu H, et al
in

face-

and Conclusion

This
quantitative
survey,
the
first
large
study in the Philippines on chronic pain in
the
general
adult
population,
has
provided
important
insights
into
the
prevalence
and
incidence of chronic pain, its impact on daily
life and the attitudes of Filipinos to treatment
and
medications.
This
study
confirms
that
economics is an important factor in seeking
pain relief. The government should recognise
chronic pain as a specific health problem,
especially when the original cause of pain
has
disappeared
or
cannot
be
cured.
The
availability
and
accessibility
of
healthcare
for sufferers should be improved, as should
the
availability
and
affordability
of
pain
medications.
Healthcare
providers
and
the
pharmaceutical industry should work together
to make pain relief and management more
affordable for the general adult population in
the Philippines.

A cknowledgements

This
study
was
designed
and
funded
by
Mundipharma
Pte
Ltd.
TNS
Trend
Philippines
conducted the field survey and data processing.
Drs
Lu
and
Javier
critically
reviewed
the
manuscript and approved the final version for
submission.

The authors thank Tina V. Garcia of In Vivo
Communications (Asia) Pte Limited for medical
writing assistance.

C onflict

of Interest

Both authors have received honoraria, lecture
fees
and
travel
grants
from
pharmaceutical
companies involved in pain management, and
have declared past funding for related work. Both
doctors are members of the advisory board for
Lyrica (Pfizer), a prescription medication used to
treat neuropathic pain and fibromyalgia.

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