There’s truly a pain epidemic in America, with over 100 million affected. The cost is greater than 650 billion dollars per year. This is about 5% of the total gross national product in the United States and 25% of all healthcare costs (Friction 2015). Without transforming the way we view pain and the strategies by which we address pain, this number will continue to grow.
The opioid epidemic is directly related to our current views and strategies about pain. Chronic pain is the most common reason for opioid dependency, which leads to more deaths than motor vehicle accidents (Friction 2015).
Here are a few important definitions:
Acute pain – an expected physiologic experience to noxious stimuli that can become pathologic, is normally sudden in onset, time limited, and motivates behaviors to avoid actual or potential tissue injuries. (National Pain Strategy)
Chronic pain – pain that occurs on at least half the days for six months or more. (National Pain Strategy)
High impact chronic pain – refers to pain associated with substantial restriction of participation in work, social, and self-care activities for six months or more (National Pain Strategy)
Biopsychosocial pain – refers to a problem or intervention that combines biological, psychological, and social elements or aspects. (National Pain Strategy)
Pain is the “Big Elephant in the Room” That No One Wants to Talk About. Now What?
Two publications have recently been published, creating a path for the future in pain care: Relieving Pain in America and The National Pain Strategy (Mackey 2016). These publications highlight the need for better pain assessment, prevention, and management.
The National Pain Strategy Vision:
“If the objectives of the National Pain Strategy are achieved, the nation would see a decrease in prevalence across the continuum of pain, from acute, to chronic, to high-impact chronic pain, and across the life span from pediatric through geriatric populations, to end of life, which would reduce the burden of pain for individuals, families, and society as a whole. Americans experiencing pain—across this broad continuum —would have timely access to a care system that meets their biopsychosocial needs and takes into account individual preferences, risks, and social contexts. In other words, they would receive patient-centered care.”
The Plan for Relieving Pain in America:
Heighten awareness about pain and its consequences
Emphasize the prevention of pain
Improve pain assessment and management in the delivery of healthcare and financing programs of the federal government
Use public health communication strategies to inform patients on how to manage their own pain
Address disparities in the experience of pain among subgroups of Americans
Pain patients deserve an evidence-based and patient-centered model of care.
Prevention is the best way to address the pain epidemic (Mackey 2016).
Acute pain, that is not properly managed, can lead to chronic pain (Mayday Fund 2009)
Providers must recognize that acute pain needs prompt treatment as a measure to prevent the chronic illness. And chronic pain, if it occurs, must be assessed and managed according to best practice with the goal of providing comfort, improved functioning, equitable care, and better quality of life (Mayday Fund 2009)
Now more than ever, there is a need for complementary health approaches to address the pain epidemic in America.
Complementary health approaches are mind and body practices and natural products of non-mainstream origin, including chiropractic and osteopathic manipulation, meditation, massage, relaxation, yoga, acupuncture, and naturopathic medicine (National Pain Strategy).
Improved provider and patient education is necessary.
Although pain is one of the most common reasons for primary care provider visits, most health education programs have yet to give pain adequate attention (National Pain Strategy).
Patients can overcome the myths and stigmas of pain, and initiate appropriate care along with self-management strategies through improved community education.
Chronic pain is a disease in and of itself, creating changes in the nervous system which may worsen over time.
Chronic pain does not only affect adults. An estimated 20% of children suffer with chronic pain (Mayday Fund 2009).
Without appropriate treatment, these children are at risk for having pain well into adulthood (Mayday Fund 2009).
My personal and professional hope is that these publications lead to improved patient-centered care, in which different disciplines truly share open lines of communication for the betterment of the patient in pain. Gaps in insurance reimbursements must begin matching the time, education, and treatments needed for providers to deliver a full spectrum of care to those in need. Finally, I hope that the myths, stigmas, and misunderstandings of pain are done away with through improved patient education.
Fricton, J. (2015). The Need for Preventing Chronic Pain: The “Big Elephant in the room” of Healthcare. Global Advances in Health and Medicine, 4(1), 6-7. doi:10.7453/gahmj.2014.075
Mackey, S. (2016). Future Directions for Pain Management. Hand Clinics, 32(1), 91-98. doi:10.1016/j.hcl.2015.08.012
National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (2018, February 27). Retrieved from https://iprcc.nih.gov/National-Pain-Strategy/Overview
Read the Report | A Call to Revolutionize Chronic Pain Care in America | Mayday Fund Special Committee on Pain and the Practice of Medicine. (n.d.). Retrieved from http://www.maydaypainreport.org/report.php