The Chronic Pain Epidemic in America Has a Flawed Approach
As of 2011, the specialty of pain management has reached a new level of monetary and social awareness. According to an NIH study recently released, over 100 million Americans suffer from chronic pain, and the total cost of this pain is well over $500 billion dollars annually.
Let’s take a look at the traditional methods of how pain management in America work. Twenty percent of office visits in America involve a narcotic prescription, with the most common being Vicodin. Narcotics are often prescribed for acute and chronic conditions. Acute conditions may include a back strain, a sporting injury, a herniated disc, or an operation. Chronic conditions may include degenerative disc disease, degenerative scoliosis, or such painful problems as diabetic neuropathy.
There is a big push in America for effective pain treatment. Undertreating pain is considered below the standard of care. So what happens? It all starts with a seemingly innocuous narcotic prescription, which all too often blossoms into repetition. Before one can blink, the narcotic prescriptions keep coming, and tolerance sets in.
There is even a condition where chronic narcotic prescriptions may exacerbate one’s pain and make it worse. This is termed opioid induced hyperalgesia (OIH). That’s sort of like taking a beta blocker to lower one’s heart rate with the end result being tachycardia! There are other significant side effects to chronic narcotics as well, such as tolerance, depression, constipation, and altered mentation.
The economy of pain management is substantial. Between doctor visits, imaging studies, narcotic prescriptions, interventional procedures, and additional therapeutic modalities, the direct cost itself is substantial. Think about this – every time a procedure is performed, it involves nursing, needles, medication, an x-ray technician, and potentially an implant. With the indirect costs, though, including lost time from work and disability, the costs become staggering.
What is wrong with our current approach to pain management? The problem is that the current treatment methods are:
1. Typically short sighted.
2. Typically too focused.
3. Too focused on narcotics.
Being short sighted is alright in a situation such as a post-operative one where short term narcotics are meant to simply help the patient while the wounds heal. But being short sighted with a patient in chronic pain will often have the patient end up in a narcotic cycle. Being focused with pain treatment might mean treating every patient with the same approach -a narcotic prescription and an injection or two.
The answer to the current problematic state of affairs is integrated medicine. This includes having different specialists treat the patient, such as pain doctors, physical therapists, chiropractors, psychologists, naturopathic doctors, life coaches, etc.
So much of pain is non-organic and may benefit from a psychological approach. This explains why 2 patients with the same painful condition respond so differently to the same treatments. Getting patients back to work and off narcotics can be possible through the combination treatments with PT and chiropractic. There are also plenty of non-narcotic medications that can help with pain such as tramadol, anti-depressants, and neuromodulating ones like gabapentin.
In a 2006 Journal of Pain article, comprehensive interdisciplinary programs were shown to be of most benefit improving pain levels, function, return to work rates, and cost containment in dealing with chronic pain. Hopefully as more pain centers begin to embrace this philosophy of dealing with chronic pain, more patients will reap the benefits of successful treatment without their lives revolving around their next narcotic dosing for pain control.