Pain relief: a shallow cause exploration

This report is a shallow cause exploration, completed in two weeks, which expands on our previous work considering pain as a potential cause area (Sharma et al., 2020).⁶ Here, we attempt to explore the relationship between pain and subjective wellbeing (SWB) more directly, both conceptually and quantitatively.

First, we try to calculate a conversion rate between self-reported pain intensity and SWB measures. However, the limited literature provides us with two potential conversion rates: a 1-point change on a 0-10 pain scale could lead to either a 0.1-point or 1-point change on a 0-10 SWB scale. Choosing one or the other leads to drastically different results when evaluating the cost-effectiveness of pain treatments.

Second, we assess the severity and scale of chronic pain in terms of life satisfaction to be large. However, we think this is likely an underestimate which will benefit from further evaluation.

Third, we offer some novel back-of-the-envelope calculations for the cost-effectiveness of several interventions to treat pain. We conclude – in agreement with Sharma et al. (2020) – that providing opioids for terminal pain and drugs for migraines are potentially cost-effective interventions. We add an analysis suggesting that psychotherapy for chronic pain could be moderately cost-effective if it can be deployed in ways that reduce costs (task-shifted, grouped, and/or digital), although we doubt it would be as cost-effective as psychotherapy for depression. We also present other interventions which we are more uncertain about but we think are worth researching further.

There are many interventions we were unable to review. Reviewing the medical literature on pain was more time intensive than for our other projects because most meta-analyses evaluated their evidence as “moderate to low” quality. Furthermore, our subjective judgement was that these meta-analyses were of lower quality than the work we typically review from the fields of economics, psychology, and global health.

The most valuable directions for further cause prioritisation research are (1) narrowing our substantial uncertainty about the conversion rates between pain scores and SWB measures, and (2) investigating the potential of advocacy campaigns to increase access to opioids.