The High Cost of Pain and Why It's So Difficult to Address

MAY 09, 2016
Joseph Chiweshe, MD
Money Pills,Pain, whether acute or chronic, has always been a moving target for those seeking to help alleviate it. A study published in the Journal of Pain estimated the national cost of pain to be in the range of $560-$635 billion dollars. A position paper from the American College of Pain Medicine said:
 
“…the quality of pain care delivery in the United States continues to fall remarkably short of the current potential for optimal care. Pain medicine remains fragmented, and the absence of a unified organizational model of pain medicine hinders the effective provision of an integrated, cost-effective pain care, causing unnecessary and avoidable human suffering and societal expense.”
 
The societal cost is comprised of direct costs of care and loss of productivity to the economy. In order the improve the fragmentation of pain management care, the ACPM recommended bolstering training, increasing the number of pain management physicians, pursuing additional federal research funding, and strengthening reimbursement policies.

However, one of the key difficulties in pain management lies in its subjectivity. It is difficult to fully understand the level of pain another individual is experiencing. Additionally, the use of opioids in the management of pain has become a major topic of debate in recent years, an issue that has been further complicated by patient use of counterfeit medications. The following are takeaways from the Centers for Disease Control and Prevention’s proposed guidelines for how to better improve opioid care. The CDC urges physicians to:
 
• Chose non-pharmacologic therapy and non-opioid pharmacologic therapy for chronic pain.
• Establish clear treatment goals with all patients.
• Discuss with patients known risks and realistic benefits of opioid therapy
• Prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.
• Prescribe the lowest effective dosage. 
• Limit use to three days or less in most cases; more than seven days will rarely be needed.
• Evaluate benefits and harms with patients within one to four weeks of starting opioid therapy for chronic pain or of dose escalation.
• Incorporate into the management plan strategies to mitigate risk. 
• Review the patient's history of controlled substance prescriptions using state prescription drug monitoring program.
• Use urine drug testing before starting opioid therapy.
• Avoid concurrent prescribing of opioid pain medication and benzodiazepines whenever possible.
• Offer or arrange evidence-based treatment for patients with opioid use disorders.

With upwards of 100 million Americans suffering from chronic pain, we must continue to bolster the healthcare industry’s capacity to adequately address pain, while also improving standardization of opioid prescribing where appropriate.  As every individual suffering from pain is unique, the management of chronic pain will continue to be an issue of importance. 



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