NCDs as a Global Economic Burden: Growth of Chronic Pain Related Disability and Relevance of Global Collaborative Research in Yoga

Namrata Pathak, Ph.D.  Research Associate, RIS

Apurva Bhatnagar, Research Assistant, RIS

 

The past few decades have seen a significant change in the global health burden of the world. Where at the start of the century, communicable diseases and malnutrition were the major causes of death, noncommunicable diseases (NCDs) have decisively replaced these to become the dominant cause of death globally. The 2016 Global Burden of Disease data affirms that as compared to  775.5 million deaths attributed to communicable diseases,  maternal, perinatal and nutritional conditions, 1,595.5 million deaths were attributed to NCDs.[1] Interestingly,  NCDs’ rapid growth affects not only developed countries, but also low- and middle-income countries.  NCDs are a cause for concern not only for their prevalence, but also because they may impose a high economic burden that could rise substantially over the coming decades. NCDs’ global economic burden has been estimated at USD47 trillion in 2010–2030 (measured in real USD with the base year 2010)—equivalent to 75% of global gross domestic product (GDP) in 2010.[2]

Associated with NCDs are morbidity and disability wherein mental illness and chronic pain are now recognised as key drivers of NCD-related morbidity and disability. Conditions such as anxiety, depression, pain, and mobility impairment place a significant burden on social welfare and healthcare systems[3]. However, while actions to monitor NCDs have gained momentum, developments in managing associated NCD-related disability have been relatively slow[4]. It is estimated that 20% of adults worldwide suffer from pain, and 10% of adults are newly diagnosed with chronic pain each year.[5] The largest causes of pain are cancer, osteoarthritis, rheumatoid arthritis, operations, injuries, and spine-related conditions. The economic impact of pain is greater than most other health conditions, due to its effects on rates of absenteeism, reduced levels of productivity and increased risk of leaving the labour market.[6] Chronic pain forms an important part of pain related disability. Studies have shown that people suffering from chronic pain have higher mortality rates suicide rate than those who don’t have chronic disorders.[7]  Worldwide, the burden caused by chronic pain is escalating. This  has been acknowledged by the World Health Organization which  has proposed a new definition of ‘chronic pain’.[8]

Acknowledging the criticality of this disability, multidisciplinary approaches to chronic pain management are being researched and implemented.  It may be noted  that chronic pains have also been responsible for increasing the drug dependency among patients most of these medicines being potentially addictive[9]. Consequently,  there has been an acknowledgement  that over-reliance on clinical medication for treatment of chronic pains might not be the most effective solution. Against this backdrop,  a ground-breaking study has revealed that mindfulness meditation and hatha yoga were found to benefit patients with chronic pain and depression, leading to significant improvement in pain levels, mood and functional capacity. Given that the total economic burden of chronic pain in US alone has been estimated to be $635 Billion, which is more than heart diseases, cancer and diabetes[10], a small-scale study was conducted in a semi-rural population in Oregon where issues of affordability, addiction and access to care are common.[11] A total of 28 participants aged 34 to 77 years who reported having chronic pain for at least one year were recruited from a community-based teaching hospital in Corvallis, Oregon for a pre-post study. According to the study, published in the Journal of the American Osteopathic Association, Patient Health Questionnaire (PHQ-9) scores, a standard measure of depression, dropped by 3.7 points on a 27-point scale.[12] Another study  published in Annals of Internal Medicine conducted among 313 people suffering from chronic low back pain, found that weekly yoga class increased the mobility of patients more than the standard medical care for the condition.[13]  There has also been a meta-analysis of 17 studies including more than 1,600 participants which concluded that yoga can help in daily function among people with fibromyalgia osteoporosis-related curvature of the spine.

The studies quoted highlight the relevance of TM systems such as Yoga in improving NCDs related morbidity, disability and even mortality around the globe. Though Yoga has witnessed worldwide commercial success with reported participation of over 300 million people,  the use of  yoga as specific health intervention against chronic pain is still lacking.   Substantial yoga research on key NCDs exists. India being the origin of this system of practice, its dedicated research councils  like the Central Council for Research in Yoga and Naturopathy have been undertaking research and clinical trials on efficacy of yoga. 682 clinical trials on yoga are indicated in the clinical trial registry of India alone[14] where almost 25 included trials on some form of pain related morbidity. However, given the scale of economic and health burden of NCDs greater policy support for international research collaboration is required to establish yoga as therapeutic intervention for chronic pain.

 

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[1] Global Burden of Disease Study. 2017. Lancet. 2018; 392 (10159): 1789-858.

[2] Bloom DE, Chen S, Kuhn M, McGovern ME, Oxley L, Prettner K. 2017. ‘The economic burden of chronic diseases: estimates and projections for China, Japan, and South Korea’, National Bureau of Economic Research Working Paper Series, 1050 Massachusetts Avenue, Cambridge, MA 02138. 2017; No. 23601. 10.3386/w23601.

[3] Lisy K, Campbell JM, Tufanaru C, Moola S, Lockwood C.,2018. The prevalence of disability among people with cancer, cardiovascular disease, chronic respiratory disease and/or diabetes: a systematic review’. Int J Evid Based Health. 2018; 16 (3): 154-66.

[4] Kruk ME, Nigenda G, Knaul FM.2015. Redesigning primary care to tackle the global epidemic of noncommunicable disease. Am J Public Health. 2015; 105 (3): 431-7.

[5] Global Burden of Disease Study 2017. Lancet. 2018; 392 (10159): 1789-858.

[6] Phillips, J. Ceri. 2009. ‘The Cost and Burden of Chronic Pain’. Reviews in Pain. Online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590036/

[7] Levy, Carol. 2020. “Where Is the Hurry to Help People With Chronic Pain?” Pain News Network. Online: https://www.painnewsnetwork.org/stories/2020/11/8/where-is-the-hurry-to-help-people-with-chronic-pain

[8] https://www.sip-platform.eu/press-area/article/world-health-organisation-proposes-new-definition-of-chronic-pain-giving-hope-to-patients

[9] Clark, M.R., Treisman, G.J. 2011. Chronic Pain and Addiction. Krager.

[10] Levy, Carol. 2020. “Where Is the Hurry to Help People With Chronic Pain?” Pain News Network. Online: https://www.painnewsnetwork.org/stories/2020/11/8/where-is-the-hurry-to-help-people-with-chronic-pain

[11] Robinson, Brian, 2020.  ‘Groundbreaking New Study Shows Yoga And Meditation Benefit Physical And Mental Health’ , Forbes., October 3, 2020 . Available at:  https://www.forbes.com/sites/bryanrobinson/2020/10/03/groundbreaking-new-study-shows-yoga-and-meditation-benefit-physical-and-mental-health/?sh=7031e4bf37fa

[12] Ibid

[13] Harvard Health Publishing, Harvard Medical School. Available at:  https://www.health.harvard.edu/alternative-and-complementary-medicine/yoga-for-pain-relief

[14] http://ctri.nic.in/Clinicaltrials/advsearch.php