Understanding Chronic Pain: Japan's Response to a Growing Global Health Issue

September marks Pain Awareness Month, an initiative started in 2001 by the World Health Assembly (WHA), a branch of the World Health Organization (WHO). This global campaign aims to shed light on chronic pain and the challenges faced by those who suffer from it. MEDICAL JAPAN stands in solidarity with this cause, striving to share insights on chronic pain and support the global effort to #SolvePainTogether.

Pain is the body’s natural response to illness or injury. However, when pain lingers for 3 to 6 months or longer, it becomes chronic, affecting various aspects of a person’s life.

How does chronic pain affect the brain? Its long-term effects can alter brain function, making it difficult to focus and remember, as the persistent discomfort disrupts the brain’s ability to process information effectively. Can chronic pain increase blood pressure? While the relationship between hypertension and chronic pain is still a matter of debate, a certain study suggests a possible association, indicating that chronic pain may contribute to elevated blood pressure in certain individuals.

Nevertheless, if chronic pain is left untreated, it can cause physical limitations, emotional distress, and social isolation.

What is the difference between acute and chronic pain? Unlike acute pain, which typically results from an identifiable injury or illness, chronic pain often lacks a clear cause and is not always alleviated by medication. The persistent nature of chronic pain can foster feelings of hopelessness and uncertainty about the future. 

Chronic pain is a significant global health issue, with an estimated 1 in 10 adults worldwide diagnosed annually. In Japan, the situation is particularly concerning. According to a report by the Health and Global Policy Institute (HGPI), 22.5% of the adult population—approximately 23.15 million people—suffer from chronic pain. This issue costs the Japanese economy around 2 trillion yen annually, primarily due to lost productivity among the working population. Additionally, Japan’s aging population makes the problem worse, as many elderly individuals require care for chronic joint diseases or long-term support.

The impact of chronic pain in Japan extends beyond physical disabilities. It is also associated with mental health challenges, social withdrawal due to absence from work, and a diminished quality of life.

How to treat chronic pain? Treating chronic pain is complex and often requires a multidisciplinary approach involving various specialists. However, Japan faces significant challenges in implementing such an approach. These challenges include a lack of collaborative systems for multidisciplinary treatment, insufficient knowledge about chronic pain among healthcare providers, and outdated practices within medical departments.

Moreover, Japan struggles to effectively utilize treatments proven to be beneficial, such as cognitive behavioral therapy (CBT) and psychotherapy. These treatments are often underfunded due to their high costs in terms of human resources.

Sustaining chronic pain treatment is another challenge. Although multidisciplinary pain centers exist in Japan, the reimbursement rates for the services provided by various specialists are inadequate. To improve these rates, it is essential to publish high-quality research that supports the effectiveness of multidisciplinary treatments.

Despite these challenges, Japan has implemented several measures and policies on how to deal with chronic pain and support people suffering from it.

In 2010, the Ministry of Health, Labour, and Welfare (MHLW) established a study group on chronic pain, which highlighted the benefits of multidisciplinary treatments. This led to the creation of multidisciplinary pain centers, with 38 facilities operating in Japan as of March 2023.

The formation of the Parliamentary Association for Chronic Pain Measures is another significant step. Japan has also been active in sharing research findings with international organizations, such as the International Association for the Study of Pain. In 2016, chronic pain countermeasures were included in "Japan’s Plan for Dynamic Engagement of All Citizens."

At the 112th HGPI Seminar in 2023, the importance of a multidisciplinary system for treating chronic pain was reiterated. Various treatments were categorized based on their effectiveness, with pharmacotherapy, trigger point injections, CBT, and acupuncture listed as Level 2 recommendations, and rehabilitation and exercise therapy as Level 1.

Recently, the HGPI Chronic Pain Project recommended enhancing the role of primary care physicians in managing complex chronic pain. Drawing inspiration from other countries, the recommendation suggests that Japan adopt a whole-of-society approach, where primary care physicians act as the first point of contact for chronic pain patients. This approach would involve continuous training for physicians on how to treat chronic pain and support them in data collection and analysis efforts. Additionally, the recommendation calls for the establishment of a collaborative system that connects primary care physicians with various community resources. This system would ensure that patients receive a comprehensive range of evidence-based interventions and timely access to multidisciplinary care.

Chronic pain is a critical social issue, both in Japan and globally. One of the most effective strategies on how to treat chronic pain is a multidisciplinary approach, where specialists work together to provide comprehensive care. Although Japan faces several challenges on how to deal with chronic pain, ongoing efforts, discussions, and research are underway to improve pain management services, ensuring better and more equitable care for all citizens.