According to a report released by the Institute of Medicine Wednesday, nearly a third of Americans experience long-lasting pain and too often feel stigma rather than relief from a health care system poorly prepared to treat them. Chronic pain is costing the nation at least $558 billion a year in medical bills, sick days and lost productivity, the report found. That's more than the cost of heart disease, the top killer.
The report summarizes that all types of ailments can trigger lingering pain, from arthritis to cancer, spine problems to digestive disorders, injuries to surgery. Sometimes, chronic pain can be a disease all its own, the report stressed.
However irrespective of the cause effective pain management is “a moral imperative,” the report concludes, urging the government, medical groups and insurers to take a series of steps to transform the field. Dr. Philip Pizzo, Stanford University's dean of medicine, who chaired the months-long probe said, “We're viewing this as a critical issue for the United States.” He added that for too long, doctors and society alike have viewed pain “with some prejudice, a lot of judgment and unfortunately not a lot of informed fact.”
Dr. Doris K. Cope, pain chief at the University of Pittsburgh Medical Center said she was not surprised with the numbers. The population's getting older and less fit, and more survivors of diseases like cancer live for many years with side effects from treatments that saved them she explained. Too many patients think a pill's the answer, she said, when there are multiple different ways to address pain including physical therapy, stress reduction, weight loss, and teaching coping skills. Patients who take control of their pain fare better, but too many have unrealistic expectations. She said, “Pain is not simple. We as physicians need to be healers and educators as well as technicians. We certainly don't want to be pill mills.”
While there is controversy regarding prescription of pain medicines, the institute countered that it's far more likely for a pain patient to get inadequate care than for a drug-seeker to walk out with an inappropriate prescription. While newer, better medicines are needed, those narcotic painkillers are a safe and effective option for the right patient, the report said.
As one member of the IOM committee, Dr. Sean Mackey, chief of Stanford University’s division of pain management, said, “Chronic pain is a disease that affects more people than heart disease, diabetes and cancer combined, and yet we spend only a small portion of the budget of the National Institutes of Health on understanding its cause or how to treat it. Our hope is that this report will serve as a wake-up call to our country.”
But barriers to good care extend far beyond that issue, said the panel, which analyzed research and the reports of more than 2,000 patients and caregivers about pain's toll. Pain is highly subjective. Two people with the same injury may feel different degrees of pain depending on genetic factors that affect pain tolerance the authors write. Pizzo called the finances sometimes perverse. He said some insurance pays for an operation for low back pain but not much cheaper and often more effective physical therapy.
The report concluded at least 116 million adults suffer long-lasting pain, consistent with some previous estimates, but couldn't say how many cases are severe or disabling. The report found health care for pain costs $261 billion to $300 billion a year, while lost productivity adds another $297 billion to $336 billion. The federal Medicare program accounts for a quarter of those health bills.
The report recommends that health care providers should perform and document formal pain assessments of patients, a step toward proper treatment. They urge Medicare, Medicaid, workers' compensation programs and private health plans should cover individualized pain care. The report recommends Pain specialty groups that should create collaborations with primary care doctors to improve patient care and counseling. The authors ask for government and health organizations to be better equipped to educate patients and the public about pain, to help eliminate stigma. The National Institutes of Health should increase pain research, including designating one of its centers as the lead institute for pain. Training programs for doctors, nurses, dentists and other health professionals should include pain education. They recommend and speculate that by the end of next year, the Health and Human Services Department should create a strategy for dealing with pain as a public health problem and reducing barriers to care.
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