About 70 million Americans suffer from some sort of chronic pain—including at least 23 million whose pain is so severe that it is disabling. Lost work hours and other pain-related costs add up to over $100 billion.
But while misuse of prescription pain medication makes headlines and has led to numerous initiatives aimed at fighting addiction, little attention is given to the impact this has on pain sufferers who vastly outnumber addicts (The most recent government statistics find that 1.7 million people currently misuse or are addicted to painkillers).
A new report [pdf] by the Mayday Fund—a charity focused on fighting pain—calls attention to this pain crisis and advocates a number of new initiatives to help. The report was the result of a June meeting that included numerous high level pain experts, physicians from multiple specialties and patient advocates.
The authors emphasize that many patients now are poorly treated because of both disproportionate fear about addiction and what one of the authors called “misaligned incentives” that result in patients receiving unnecessary and often pain-increasing treatments.
For example, doctors who attempt to treat pain with injections and surgery can make 10 times more an hour than they can by prescribing medications which are less invasive and often more effective. Surgeries and nerve block injections also don’t carry the risk of scrutiny by law enforcement.
The report says that pain patients
…often endure repeated tests and inadequate or unproven treatments. This may include unnecessary surgeries, injections or procedures that have no long-term impact on comfort and function. Patients with chronic pain have more hospital admissions, longer hospital stays and unnecessary trips to the emergency department. Such inefficient and even wasteful treatment for pain is contributing to the rapid rise in health care costs in the United States.
To improve the situation, the authors suggest that the government change its reimbursement policies for pain treatment to change these incentives and that physicians be better educated in medical school about pain. They also call for less emphasis on law enforcement needs and more on those of patients:
Federal, state and local agencies should publicly adopt a balanced approach to the regulation of controlled prescription drugs, particularly opioids. The clinical decisions of prescribers should not be inappropriately influenced by fear of regulatory scrutiny. Research has shown that state laws continue to harbor requirements that are outdated or reflect poor medical practice.
The authors also want to see an increased the proportion of the NIH budget devoted to pain. Right now, NIH has two separate institutes on addictions (NIDA and NIAAA) and spends nearly $1.5 billion to study them. Just $287 million is spent researching chronic pain conditions and there is no institute devoted to studying pain.
The Mayday report was endorsed by the advocacy arm of the American Cancer Society, as well as numerous medical specialty societies including those for pain specialists and ranging from the American Academy of Neurology to the American Academy of Pediatrics.