Not only does chronic pain affect the quality of life of over 116 million Americans, there is a massive economic burden too, estimated to be between $560 and $635 billion each year for the country, researchers from the Committee on Advancing Pain Research, Care, and Education; IOM (Institute of Medicine) revealed in a report issued today. The authors added that a considerable proportion of chronic pain is preventable, or could be treated more effectively.
Chronic pain is pain that persists and/or progresses over a long period. The British Pain Society defines it as pain that persists for "more than 12 weeks or after the time that healing would have been thought to have occurred ..." Chronic pain is related to several medical conditions, including shingles, sciatica, diabetes, migraine, arthritis, cancer, and many others.
The authors say that a cultural transformation is urgently needed on how Americans understand and approach pain prevention and management. There should be a coordinated approach at national level - it should include all types of organizations, public and private.
Some changes that the report recommends could be put into action by the end of next year, while others by the end of 2015 if everybody pulled together, they added.
Committee chair Philip Pizzo said:
"Given the large number of people who experience pain and the enormous cost in terms of both dollars and the suffering experienced by individuals and their families, it is clear that pain is a major public health problem in America. All too often, prevention and treatment of pain are delayed, inaccessible, or inadequate. Patients, health care providers, and our society need to overcome misperceptions and biases about pain. We have effective tools and services to tackle the many factors that influence pain and we need to apply them expeditiously through an integrated approach tailored to each patient."
Chronic pain incurs medical costs and causes lost working days and wages to an estimated total of between $560 and $635 million every year in the USA. This is a conservative estimate, the authors stress, as it does not include children or military personnel.
A patient with chronic pain needs a combination of therapies and coping techniques - this is something insurers, health care providers, and the general public need to understand. Even though pain is universal, therapies must be tailored towards each individual's situation.
Chronic pain can damage the nervous system and end up turning into a different chronic disease - it is more than a mere physical symptom. In many cases, chronic pain cannot be resolved simply by treating and curing the underlying condition.
The way we experience and interpret pain is influenced by several factors, including our genes, how much stress we are exposed to, whether or not we have developed depression too, being informed about health issues, our cultural attitudes toward hardship, and other emotional, cultural and behavioral components.
The authors concluded that only with an integrated approach that addresses all the contributory factors, can the treatment, management and prevention of pain be effective.
Primary care providers and the patients themselves should continue undertaking the majority of pain care and management. In more complex cases, specialty care services should be instantly available.
The authors wrote:
"Health care organizations should take the lead in developing innovative approaches and materials to coach and empower patients in self-management. "
Pain education should be included in all training programs for health care professionals, such as physicians, nurses, and dentists. Interdisciplinary learning should be encouraged.
A significant proportion of health care professionals are not properly trained or prepared to provide the whole range of pain care, or to help the patient self-manage his/her chronic pain effectively.
According to a recent study, out of 133 medical schools in the USA, only 5 have mandatory courses on pain, and only another 17 offer elective courses.
The authors added:
"Licensing and certification exams should include assessment of pain-related knowledge and capabilities. Programs that train specialists or offer training in advanced pain care need to be expanded.
Workers' compensation programs, private health plans, and Medicare/Medicaid workers urgently need to find ways to cover interdisciplinary pain care.
Patient-tailored care requires more than just one form of therapy; it involves counseling to patients and their families, as well as consultations with various providers. Unfortunately, reimbursement systems in the USA today are not designed to cope with this efficiently, and health care organizations are not set up for integrated patient management.
The NIH (National Institutes of Health) needs to dedicate more resources to pain therapy, and to give it a higher priority. The authors believe the NIH should increase the scope and resources of its existing Pain Consortium by designating a lead institute to push pain R&D forward. This should be done with the collaboration of the public and private sectors, academic researchers and some other organizations.
"Synopsys of the report"
Written by Christian Nordqvist