KANSAS CITY, Mo. — America is a nation racked with pain that's too often unacknowledged and inadequately treated, a panel of experts reported Wednesday.
At least 116 million U.S. adults — about one-third of the nation's population — live with chronic pain. Along with its toll in suffering, chronic pain costs society an estimated $560 billion to $635 billion a year in medical bills and lost productivity, according to a report by the Institute of Medicine.
More people are in chronic pain than the combined number with heart disease, diabetes and cancer, the report said. The number of people who say they're in pain has grown steadily in recent years, and that trend is expected to continue as the population ages.
"It is morally unconscionable. We have 116 million people struggling every day with chronic pain. It is a moral duty of people in health care to address this issue," said Myra Christopher, president of the Kansas City, Mo.-based Center for Practical Bioethics and a member of the 19-person panel that wrote the report.
Pain treatment is hampered by inadequate training of doctors, insufficient insurance reimbursements and the negative attitudes of both doctors and patients toward people in pain, said the report, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research."
Along with a long list of specific recommendations for improving pain research and treatment, the report called for a "cultural transformation" in the way the public and medical professionals regard pain.
People may avoid seeking treatment out of a belief that pain has a divine purpose, or out of resignation that pain can't be alleviated, the report said. Some may fear that complaining about pain will be seen as a sign of weakness.
"Many of us were raised to just suck it in and go on. Athletes are trained 'no pain, no gain,' " Christopher said.
Doctors sometimes trivialize their patients' experiences with pain, the report said, especially when their pain doesn't appear to be tied to an identifiable illness or injury.
"I hear doctors say, 'I have people come to my office and I feel they are trying to scam me (for narcotic drugs),' " Christopher said. "Frankly, I believe chronic pain patients are suffering needlessly because of this confusion over drug diversion."
Pain takes many forms and has many causes, including the acute pain of a traumatic injury, the throbbing head of a migraine and the excruciating nerve pain of shingles. Social and psychological issues — for example, the strain of poverty, depression or post-traumatic stress — can intensify how pain is experienced.
The latest research, cited by the report, finds that chronic pain can occur on its own long after an illness or injury is gone. The original pain may "rewire" the nervous system to respond with pain to the least stimulation, such as a light touch or gentle breeze.
" 'It's not in your head' is a message we want to convey," said Philip Pizzo, dean of Stanford University medical school and chairman of the Institute of Medicine panel. "For many patients, chronic pain becomes a disease in its own right."
Pizzo said the report's estimate of the number of people in pain is conservative because it does not include children or military personnel.
Patients often go years without being adequately diagnosed or treated, the report said.
Jerry Medol, 68, started getting back pain at least 20 years ago. For the past decade he needed a cane to get around. But he decided to tough it out and didn't seek help until last year, when the pain became unbearable.
"The truth was, I tolerated it. I lived with it," the Kansas City anger management instructor said. "I didn't realize how seriously, how profoundly my situation had deteriorated."
In October, he had surgery at the University of Kansas Hospital for pinched nerves in his back. In March, he another operation to replace an arthritic hip. Now he's getting physical therapy and can walk unassisted.
"It's absolutely night and day," Medol said.
Roxanna Clemons, 51, of Topeka, Kan., was stepping into her Jeep in a convenience store parking lot when it was rear-ended by another car. That accident in 2000 sent her to the emergency room with an injured leg and then to a series of doctors who couldn't ease her intractable pain. The once-active woman, who worked as many as four jobs at a time, was bedridden for years.
"I couldn't function. I was angry. I was upset. In a way, my life was taken away from me," Clemons said. "I finally started crying in the doctor's office. 'Nothing you're doing is helping.' "
Ultimately, Clemons was referred to the pain clinic at KU Hospital, which provides wide-ranging treatments by doctors, psychologists, physical therapists and other care providers.
After fighting for insurance coverage for the procedure, Clemons' KU doctor, Talal Khan, implanted a device that sends electrical signals to her spinal cord. Now, most of her pain is gone. Clemons walks a mile each day for exercise and has lost about 75 pounds, much of that weight gained from taking pain medications.
"I wanted to get better and I got better," Clemons said. "I got my life back."
Kahn said he sees patients who have suffered years, even decades, with pain that hasn't been adequately treated.
"It starts to unravel almost every relationship in their life. They lose their spouse, friends, their job. It rules their life to the exclusion of all else," he said.
These patients may seek relief from health care providers who don't have the expertise to handle complex pain cases on their own, Kahn said.
For example, a surgeon may not know how to manage chronic post-operative pain.
"Patients are given a truckload of narcotic medications, but the underlying problem is never explained to them," Kahn said.
The Institute of Medicine report pointed out numerous shortcomings in pain treatment. Among them:
—While 10 percent of all prescriptions for adults are for pain medications, little innovation is occurring to create new drugs. Newly introduced drugs have mostly been variations on existing medications, and many drug companies are leaving the pain market entirely.
—People in pain typically first seek help from primary care doctors, such as family physicians. But these doctors often receive little formal training in pain management. Nationwide, only about 3,500 certified pain specialists are serving patients, and many people do not have access to comprehensive pain centers.
—Insurance plans may cover surgery and other procedures for pain patients, but they provide little coverage for rehabilitation or psychological counseling. That creates what the report called "perverse incentives" to do costly operations when other kinds of care may be more effective and less expensive.
The pain report was mandated by Congress as part of its health care overhaul legislation. The Institute of Medicine is a nonprofit organization that was created to provide independent advice to policymakers, health professionals and the public.
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BY THE NUMBERS
—80 percent of patients undergoing surgery report experiencing postoperative pain.
—60 percent of patients visiting U.S. emergency rooms with acute painful conditions who receive analgesics. The media time to receive pain medication is 90 minutes.
—2.1 million annual visits to U.S. emergency rooms for acute headache pain.
—62 percent of U.S. nursing home patients report pain — arthritis is the most common.
—26.4 percent of Americans report low back pain lasting at least a day in the last three months.
Source: Institute of Medicine
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