Poor housing, poverty and isolation all contribute to the experience of pain and desperately need to be addressed
Thu 13 Feb 2020 01.00 EST
Last modified on Thu 13 Feb 2020 08.14 EST
I’m writing this column on codeine. Chronic illness means I’ve been taking painkillers daily for two years, and I’m not the only one: between 2017 and 2018, 5.6 million adults in England were taking opioids; of those, 540,000 had been taking them for at least three years. It’s a strange beast to deal with, permanent illness. Humans are used to acute pain – a stubbed toe, childbirth, a broken arm. We are not designed for lasting pain, the sort that rears its head on an ordinary Tuesday morning and is still there five long years later. We don’t really know how to talk about it, or provide ways of coping.
There’s been a flurry of headlines in recent months warning of the increasing use of painkillers, particularly opiates, in the UK. GP prescriptions in England for opioids – drugs such as morphine and oxycodone – doubled between 2007 and 2017 to 23.8m.
Overuse of painkillers is a serious issue, as is the fact that many people take medication that ultimately doesn’t make them feel better (it’s thought as few as one in 10 patients with chronic pain not linked to cancer may benefit from such drugs), or leaves them vulnerable to addiction. But for those of us whose health conditions leave us in need of pain relief, a discussion on this level can feel far from useful. There’s little good in warning people against painkillers when so few alternatives are offered.
It’s refreshing, then, to hear a leading doctor suggest social interventions, such as mental health support, should be prescribed alongside drugs to patients with long-term conditions. “Maybe we can’t change the pain, but we can do various things: like we can improve mobility, we can improve sleep, we can improve social isolation, we can provide housing support, we can provide financial advice,” says Dr Cathy Stannard, clinical lead for guidelines on chronic pain at the National Institute for Health and Care Excellence.
The stats suggest this is a major public health issue: almost half the adult population of the UK – 28 million people – may be living with chronic pain. Debilitating pain isn’t just unpleasant; it can mean losing your job, damaging personal relationships, or being housebound. For all its wonder, the NHS is largely unequipped to deal with the problem. It’s common for people with chronic health problems to get a diagnosis (if they’re lucky), but next to no help on living well with the condition. Recent calls for the NHS to provide more psychological help for women dealing with a miscarriage are a window to the therapeutic support that could be offered to anyone dealing with the daily difficulty of pain. It does not mean pain is “all in our head” to acknowledge the link between physical and mental health.
But, as Stannard argues, to really tackle this, we need to look beyond the NHS. Thinking about health in the round – from what homes we provide to how we interact in our community – is crucial to improving the lives of people with chronic conditions. Poverty compounds pain, as does isolation, and yet it’s those in long-term pain who are more likely to be poor and isolated. Half of the people who use food banks belong to a family where one member is disabled. Only 7% of England’s housing stock provides even the most basic features of accessibility. Almost half of working-age disabled people say they “always or often” feel lonely. One study found that half of homeless people have a chronic pain condition (almost four in 10 said physical pain had actually contributed to them becoming homeless). It’s not hard to see how this all adds up. Arthritis is crippling when you can’t afford to put the heating on after you’ve had your benefits cut. Hip pain will only get worse if you have to crawl up the stairs to bed because there’s no accessible social housing.
Anyone who says providing these kinds of solutions is too costly has likely never been in agony themselves. Besides, compassion is good maths. All the evidence points to the fact that healthier, happier citizens are better for a society. Governments are slowly coming round to the idea that wellbeing is a more sensible measure of success than GDP, and easing people’s physical suffering seems a fitting place to start.
Painkillers, prescribed safely, are vital for many, and addressing the stigma and misinformation around their long-term use is key. But considering the bigger picture – from housing to food poverty – is both smart and humane. On an ordinary Tuesday, wincing from a sudden ache, any one of us may find ourselves in need of such support.
• Frances Ryan is a Guardian columnist