Chronic pain: Spain's invisible illness affecting one in four

Chronic pain affects one in four people in Spain and forces a third of patients to give up their jobs, at an estimated cost of 2.5% of GDP. The lack of an objective way to measure it leaves many sufferers feeling they are not believed.

Blanca Ortiz was 28 and in her second year of university when a birth malformation was detected in one of her lumbar vertebrae. On **3 September 2018** she walked into the operating theatre and left the hospital two months later unable to walk. She spent a year lying in an adjustable hospital bed, with pain she herself rated **10 out of 10**. Even morphine did not relieve it. Eight years later, she still cannot remember what it is like to live without pain.

Her case is not a statistical exception. Chronic pain affects **one in four people in Spain**, according to the Pain Observatory at the University of Cádiz. It is an illness that cannot be seen, that has no marker in a blood test, and that is often mistaken for complaining or weakness. And yet it carries weighty economic figures.

## A third of patients stop working

**32.3%** of people with chronic pain have had to give up their jobs, according to the latest data from the Pain Observatory, from **2022**, which is updated every four years. The impact on the Spanish economy is estimated at a negative burden of **2.5% of GDP**. That is no small figure: we are talking about production that never happens, social security contributions that are never collected and benefits that must be paid.

Lara González was 32 when a wrist operation that went wrong left her with pain she describes as a burning bar pressing on her arm. She spent five years in constant pain of **8 out of 10** with no one able to explain what was happening. At first she did not stop working: in the mornings she went to the office and in the afternoons she took morphine at the hospital. Later she was granted disability leave. She was 52 when she told this story, twenty years after it began.

The illness also has a mental dimension that the statistics capture. **22.2%** of patients suffer from depression and **27.6%** from anxiety, according to the latest chronic pain barometer in Spain. The lack of rest and the constant pain make hopelessness the most widely shared state of mind, explains Alexandra Alonso, co-founder of the National Pain Institute.

## Ten and a half months of waiting for the first appointment

One of the factors that weighs most heavily on the prognosis is time. The average wait for a first appointment at a Pain Unit is **10.5 months**, according to the barometer. And **38%** of patients wait between one and five years from the onset of symptoms until they are referred to a specialised unit. "Every month of delay works in favour of chronification," Alonso argues.

Dr **Javier de Andrés**, head of the Pain Unit at Hospital de La Paz, sums it up with an everyday scene: he tells those who do not suffer from the illness to put a stone in their shoe and walk around all day. The underlying problem is that no pain meter exists. There is no way to measure pain objectively; it is always the patient who rates it. And in practice, that means many people are not believed.

Invisibility carries an added cost. Blanca Ortiz tells it without drama: she stays calm during the conversation until she pauses and warns that at that moment she is in a lot of pain. The worst thing, she says, is that people do not believe her. She has a spinal cord stimulator implanted in her back, a device that works like a pacemaker, emitting electrical impulses to cut the connection between the pain and the brain. The pain does not go away: it stays between **7 and 10 out of 10**. Doctors encourage her to keep using it because they believe she has not been wearing it for long.

## Chronic pain has been classified as an illness since 2019

Pain has always existed, but chronic pain has only been considered an illness rather than a symptom since **2019**, when the World Health Organization included it in the International Classification of Diseases. That change is not bureaucratic: it means recognising that there is a pain that does not signal an active injury and that requires treatment of its own.

The most common profile at pain units, according to De Andrés, is a middle-aged woman. The study by the Pain Observatory and the **Grünenthal** foundation, a private non-profit organisation, confirms that the condition hits women harder and knows no age. Although it has increased among young people in recent years.

The treatment that works, according to Alonso, is interdisciplinary: medicine, physiotherapy, physical activity, psychology and nutrition. Five areas that are not always coordinated or covered by the public system. Blanca Ortiz found a specialist who offered her a **10-hour** operation with a very high risk to her life. She accepted. The illness gave her a three-year truce during which she was able to walk again, study, work and go on Erasmus to France. In **2023** the stabbing pains in her lower back returned. She then knew she would never be able to work again.

Lara González also chose to have surgery when a doctor told her it was possible. Either it went well or, in her words, it would end her life. The operation was not a complete success, but it lowered her pain by about two points. She has learned to accept the illness, though she admits to hard moments of depression. There was a time when she could not even look at her own arm.

What she asks for, if she had to ask for anything, is a jolt of energy. She has not slept well in twenty years. That is the part that does not show up in the productivity statistics, but it explains why chronic pain is an economic as well as a health issue. And why invisibility, the kind that makes no one believe you, also comes at a price.