Chronic pain is often thought of as a symptom, but not a cause of disability. One research team at the University at Buffalo, however, recently established in a new study that chronic pain is contributing to rising disability rates. Last week, WBFO's Emyle Watkins spoke with Hangqing Ruan, PhD, a post-doctoral research fellow at the University at Buffalo about the study he and his colleagues co-authored. This interview has been edited for length and clarity.
EXTENDED INTERVIEW
TRANSCRIPT
This is a rush transcript provided by a contractor and may be updated over time to be more accurate.
This is an extended cut of the interview - the same audio used on air is included in this. This interview has been edited for length and clarity.
Emyle Watkins: So, I'd love to start off by hearing a little bit about you and your expertise.
Hangqing Ruan: As I've just mentioned, I've got a PhD in sociology at University of Maryland and my specialized area is health, social determinants of health and before that I had a bachelor degree and a master degree in China. One is about sociology and another is about demography. So, in general, my research area is really focused on how our social determinants affect people's health, affect health disparities, especially in disability and mortality and some chronic conditions and also some depression or subjective well-being. So, that's the basic area I'm doing both in PhD and currently.
Emyle Watkins: And what made you decide to study chronic's pain's influence on disability prevalence?
Hangqing Ruan: Yeah, so that's a long story. I did a lot of study about the disability's race at the population level. The basic thing is we want to check the changes of disability prevalence over time. So, we know for example in the U.S. there is a decline trends in 18s and even 19s, but since the 2000s we observed that this kind of decline has slowed down or even stopped or even rising in some disability measures. So, we are examining what kind of factors are driving this worsening trends. So, I had a paper during my PhD, we found some chronic conditions and the pain, they are some very, very significant driving factors. So, that's the background.
I didn't do much pain research before that, but because of that paper we found pain is a really important factor. So, we dive into that part of literature or research background and we found, "Okay, there is amazing research team at the University of Buffalo." So, then after I graduated I just reach out, "Okay, if there is this kind of research area and opportunity and a postdoc there." So, I just go to apply for that and the interview and I was a good fit, so that's why I'm here.
Emyle Watkins: Tell me a little bit more about the study you just completed. What were you hoping to learn and what were the results of the study?
Hangqing Ruan: We found the disability risk, especially among middle-aged adults and some older adults has ceased to decline or even rising. So, at the same time we know pain is increasingly recognized as public health crisis. So, we wanted to know if there is a link between two phenomenon. So, I think the most important finding of our paper is that we found a lot of people with disabilities attribute the cause of their disability to pain. So, that's the first big findings, and then we found the people attribute disability to pain has been rising very, very vastly.
For example, we found the prevalence of disability, we use... Because disability has a lot of different kinds of measurements. We use functional limitation as our measurement. Functional limitation means physical difficulties in doing like walking several miles or lifting 10 pound objects or climbing stairs, it's those kinds of things.
We found the prevalence of functional limitation rising from 43% to 50% over the past 70 years and 40% of that increase could be attributed to rising pain prevalence. So, that's a lot. So, we did some simple estimate, we found during 2002, 2018 there might almost about increase in 10 million people in the U.S., middle-aged and older U.S. attribute their disability to chronic pain. So, it's a large number. It affects so many people in the U.S.
Emyle Watkins: Did you also find any information about why that rate of chronic pain may be increasing? Were there any information about any rise in painful conditions?
Hangqing Ruan: So, the rise in the cause of that pain sense is beyond the scope of that paper, but we do have some other papers in our research team trying to explain. So, firstly why pain happens. So, it's still not well understood, even in medical researchers. We still don't understand why some pain happens because sometimes people just feel pain with no medical conditions, but more and more evidence shows that pain is quite related to their life experience. For example, the stress in their daily life and some stressful life events, their work, their family.
So, this kind of sense is a big contributor. So, that's why we are trying to link the social factors to pain, because we found it's not just the medical story, it's a social life story. We did a lot of things about disparities in pain. So people from low-income families or minority groups and women, they experienced more pain and the pain are also more harmful to them. They are more easily to be disabled because of pain. So, that's also related to our healthcare systems management tools. A lot of the things are contributing to the pain story.
Emyle Watkins: How do you think this study might influence or impact how we approach disability and chronic pain in the U.S.?
Hangqing Ruan: So firstly, our study is the first systematical study using national data to highlight pain as a contributor to disability trends. Even in our team's other studies we found pain is associated with many kinds of disability. For example, in this paper we focus on functional limitation, but in other papers we found pain is related to inability to work, inability to do leisure and participate social activities. So, the pain is very, very, it's affect a lot of disability measures.
So, we want this paper as a call to action for health care provider, policymaker and also researcher to work together to tackle this growing challenge. Especially when we think about a lot of disparities in pain and disability. So, we need to have more policies or interventions to make. We do have a lot of tools to, for example, to manage our pain conditions, to reduce pain's influence on disability. We can do as well I know physical activities, healthy lifestyles, and we also have a lot of pain management tools from a healthcare provider. But the thing is that we should make it more available to people from a disadvantaged group. So, that's important. Would you have tools, but it heavily unevenly distributed across population, so that's a big challenge.
Emyle Watkins: What are some things that you hope government officials and healthcare officials and the different people who have the ability to make change for these populations, what are some things you hope that they're thinking about after reading your study or maybe questioning?
Hangqing Ruan: I think the biggest thing I'm thinking of is pain management. So, honestly we don't have 100% of effective pills or something to pain has caused a lot of a burden of diseases. We know a lot of things about opioid use, so pain do cause a lot of social consequence in our U.S. society, but a lot of pain management things can be done by patient side. For example, as I just mentioned, the lifestyle, the physical activity, and also a lot of things can be done by the society side. For example, how to make people's work life and family life less stressful.
We need a lot of, for example, family-supportive policies, work-related policies, support people from disadvantaged group, from for example, for mom care for children, and at the same time be responsible for a lot of work. So, this stress, we can do a lot in this side, even though we don't know the mechanism of pain currently. I don't know, because I'm a social researcher, I heavily rely on that social part to do something to improve people's life.
