Editing Chronic pain (section)

== Prognosis ==
Chronic pain can significantly reduce individuals' quality of life, productivity, and wages, worsen existing health issues, and provoke the onset of new conditions like [[Major depressive disorder|major depression]], [[anxiety disorder]]s, and [[substance use disorder]]s.<ref name="Dydyk-2023" /> 

Many of the often-used medications for chronic pain carry risks for side effects and complications. For example, chronic use of opioids is associated with decreased life expectancy and increased mortality of patients relative to non-users.<ref>{{Cite journal|last1=Cavalcante|first1=Alexandre N.|last2=Sprung|first2=Juraj|last3=Schroeder|first3=Darrell R.|last4=Weingarten|first4=Toby N.|date=July 2017|title=Multimodal Analgesic Therapy With Gabapentin and Its Association With Postoperative Respiratory Depression|url=https://pubmed.ncbi.nlm.nih.gov/27984223/|journal=Anesthesia and Analgesia|volume=125|issue=1|pages=141–146|doi=10.1213/ANE.0000000000001719|issn=1526-7598|pmid=27984223|s2cid=11637917|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133502/https://pubmed.ncbi.nlm.nih.gov/27984223/|url-status=live}}</ref><ref>{{Cite journal|last1=Gomes|first1=Tara|last2=Greaves|first2=Simon|last3=van den Brink|first3=Wim|last4=Antoniou|first4=Tony|last5=Mamdani|first5=Muhammad M.|last6=Paterson|first6=J. Michael|last7=Martins|first7=Diana|last8=Juurlink|first8=David N.|date=2018-11-20|title=Pregabalin and the Risk for Opioid-Related Death: A Nested Case-Control Study|url=https://pubmed.ncbi.nlm.nih.gov/30140853/|journal=Annals of Internal Medicine|volume=169|issue=10|pages=732–734|doi=10.7326/M18-1136|issn=1539-3704|pmid=30140853|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133514/https://pubmed.ncbi.nlm.nih.gov/30140853/|url-status=live}}</ref> [[Acetaminophen]], a frequently used drug in chronic pain management, can cause [[hepatotoxicity]] when taken in excess of four grams per day,<ref>{{Cite journal|last1=Watkins|first1=Paul B.|last2=Kaplowitz|first2=Neil|last3=Slattery|first3=John T.|last4=Colonese|first4=Connie R.|last5=Colucci|first5=Salvatore V.|last6=Stewart|first6=Paul W.|last7=Harris|first7=Stephen C.|date=2006-07-05|title=Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial|url=https://pubmed.ncbi.nlm.nih.gov/16820551/|journal=JAMA|volume=296|issue=1|pages=87–93|doi=10.1001/jama.296.1.87|issn=1538-3598|pmid=16820551|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133459/https://pubmed.ncbi.nlm.nih.gov/16820551/|url-status=live}}</ref><ref>{{Cite journal|last1=Holubek|first1=William J.|last2=Kalman|first2=Susanne|last3=Hoffman|first3=Robert S.|date=April 2004|title=Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study|url=https://pubmed.ncbi.nlm.nih.gov/16557558/|journal=Hepatology|volume=43|issue=4|pages=880; author reply 882|doi=10.1002/hep.21106|issn=0270-9139|pmid=16557558|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133500/https://pubmed.ncbi.nlm.nih.gov/16557558/|url-status=live}}</ref> and even therapeutic doses administered to pain patients with [[chronic liver disease]] may cause hepatotoxicity. <ref>{{Cite journal|last1=Jalan|first1=Rajiv|last2=Williams|first2=Roger|last3=Bernuau|first3=Jacques|date=2006-12-23|title=Paracetamol: are therapeutic doses entirely safe?|url=https://pubmed.ncbi.nlm.nih.gov/17189017/|journal=Lancet|volume=368|issue=9554|pages=2195–2196|doi=10.1016/S0140-6736(06)69874-7|issn=1474-547X|pmid=17189017|s2cid=40299987|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133502/https://pubmed.ncbi.nlm.nih.gov/17189017/|url-status=live}}</ref> Long-term risks and side effects of opioids, another class of analgesic, include [[constipation]], [[drug tolerance]] and [[Drug dependence|dependence]], [[nausea]], [[indigestion]], [[arrhythmia]] (e.g., [[QT prolongation]] during [[methadone treatment]]), [[endocrine gland]] disruptions promoting [[amenorrhea]], [[erectile dysfunction]], and [[gynecomastia]], and fatigue. A major [[public health]] and clinical concern in and since the 2010s has been [[opioid overdose]], especially in the context of an [[opioid epidemic in the United States]].<ref name="Dydyk-2023" /><ref>{{Cite journal|last1=Lee|first1=Marion|last2=Silverman|first2=Sanford M.|last3=Hansen|first3=Hans|last4=Patel|first4=Vikram B.|last5=Manchikanti|first5=Laxmaiah|date=2011|title=A comprehensive review of opioid-induced hyperalgesia|url=https://pubmed.ncbi.nlm.nih.gov/21412369/|journal=Pain Physician|volume=14|issue=2|pages=145–161|doi=10.36076/ppj.2011/14/145|issn=2150-1149|pmid=21412369|archive-date=2023-11-16|access-date=2024-01-24|archive-url=https://web.archive.org/web/20231116123814/https://pubmed.ncbi.nlm.nih.gov/21412369/|url-status=live}}</ref>

As of 2011, drug treatments for chronic non-cancer pain reduced pain by 30%, although effectiveness varied widely by modality, diagnosis, and population studied.<ref>{{Cite journal|last1=Turk|first1=Dennis C.|last2=Wilson|first2=Hilary D.|last3=Cahana|first3=Alex|date=2011-06-25|title=Treatment of chronic non-cancer pain|url=https://pubmed.ncbi.nlm.nih.gov/21704872/|journal=Lancet|volume=377|issue=9784|pages=2226–2235|doi=10.1016/S0140-6736(11)60402-9|issn=1474-547X|pmid=21704872|s2cid=24727112|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133500/https://pubmed.ncbi.nlm.nih.gov/21704872/|url-status=live}}</ref> This reduction in pain can significantly improve patients' performance and quality of life. However, the general and long-term prognosis of chronic pain shows decreased function and quality of life.<ref>{{Cite journal|last1=Farrar|first1=John T.|last2=Young|first2=James P.|last3=LaMoreaux|first3=Linda|last4=Werth|first4=John L.|last5=Poole|first5=Michael R.|date=November 2001|title=Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale|url=https://pubmed.ncbi.nlm.nih.gov/11690728/|journal=Pain|volume=94|issue=2|pages=149–158|doi=10.1016/S0304-3959(01)00349-9|issn=0304-3959|pmid=11690728|s2cid=11875257|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133500/https://pubmed.ncbi.nlm.nih.gov/11690728/|url-status=live}}</ref> Also, this disease causes many complications and increases the possibility of death of patients and suffering from other chronic diseases and [[obesity]].<ref name="Dydyk-2023" /> Similarly, patients with chronic pain who require opioids often develop drug tolerance over time, and this increase in the amount of the dose taken to be effective increases the risk of side effects and death.<ref name="Dydyk-2023" />

Mental disorders can amplify pain signals and make symptoms more severe.<ref>{{Cite journal|last=Price|first=D. D.|date=2000-06-09|title=Psychological and neural mechanisms of the affective dimension of pain|url=https://pubmed.ncbi.nlm.nih.gov/10846154/|journal=Science|volume=288|issue=5472|pages=1769–1772|doi=10.1126/science.288.5472.1769|issn=0036-8075|pmid=10846154|bibcode=2000Sci...288.1769P|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133502/https://pubmed.ncbi.nlm.nih.gov/10846154/|url-status=live}}</ref> In addition, comorbid psychiatric disorders, such as major depressive disorder, can significantly delay the diagnosis of pain disorders.<ref>{{Cite journal|last1=Clark|first1=Lauren|last2=Jones|first2=Katherine|last3=Pennington|first3=Karen|date=November 2004|title=Pain assessment practices with nursing home residents|url=https://pubmed.ncbi.nlm.nih.gov/15466611/|journal=Western Journal of Nursing Research|volume=26|issue=7|pages=733–750|doi=10.1177/0193945904267734|issn=0193-9459|pmid=15466611|s2cid=42887748|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133459/https://pubmed.ncbi.nlm.nih.gov/15466611/|url-status=live}}</ref> Major depressive disorder and generalized anxiety disorder are the most common comorbidities associated with chronic pain. Patients with underlying pain and comorbid mental disorders receive twice as much medication from doctors annually as compared to patients who do not have such co-morbidities.<ref name="Closs-2002">{{Cite journal|last1=Closs|first1=S. José|last2=Briggs|first2=Michelle|date=July 2002|title=Patients' verbal descriptions of pain and discomfort following orthopaedic surgery|url=https://pubmed.ncbi.nlm.nih.gov/11996877/|journal=International Journal of Nursing Studies|volume=39|issue=5|pages=563–572|doi=10.1016/s0020-7489(01)00067-0|issn=0020-7489|pmid=11996877|archive-date=2024-01-15|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240115133514/https://pubmed.ncbi.nlm.nih.gov/11996877/|url-status=live}}</ref> Studies have shown that when coexisting diseases exist along with chronic pain, the treatment and improvement of one of these disorders can be effective in the improvement of the other.<ref name="Tang-2006">{{Cite journal|last1=Tang|first1=Nicole K. Y.|last2=Crane|first2=Catherine|date=May 2006|title=Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links|url=https://pubmed.ncbi.nlm.nih.gov/16420727/|journal=Psychological Medicine|volume=36|issue=5|pages=575–586|doi=10.1017/S0033291705006859|doi-broken-date=14 January 2025|issn=0033-2917|pmid=16420727|s2cid=30586505|archive-date=15 January 2024|access-date=24 January 2024|archive-url=https://web.archive.org/web/20240115081635/https://pubmed.ncbi.nlm.nih.gov/16420727/|url-status=live}}</ref><ref name="Petrosky-2018">{{Cite journal|last1=Petrosky|first1=Emiko|last2=Harpaz|first2=Rafael|last3=Fowler|first3=Katherine A.|last4=Bohm|first4=Michele K.|last5=Helmick|first5=Charles G.|last6=Yuan|first6=Keming|last7=Betz|first7=Carter J.|date=2018-10-02|title=Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System|journal=Annals of Internal Medicine|volume=169|issue=7|pages=448–455|doi=10.7326/M18-0830|issn=1539-3704|pmc=6913029|pmid=30208405}}</ref> 

Patients with chronic pain are at higher risk for [[suicide]] and [[suicidal thought]]s. Research has shown approximately 20% of people with suicidal thoughts, and between 5 and 14% of patients with chronic pain commit suicide.<ref name="Tang-2006" /> Of patients who attempted suicide, 53.6% died of gunshot wounds, and 16.2% died of opioid overdose.<ref name="Petrosky-2018" />