Patients in Chronic Pain Are Undertreated

2010-01-05 10:42

Two new reports highlight the fact that people who are living with significant or chronic pain are undertreated. Specifically, at least 30 percent of individuals with moderate chronic pain and more than 50 percent who are living with severe chronic pain are not receiving adequate pain relief.

“Many people suffer needlessly with pain that could be treated,” according to pain management expert Kathryn Hahn, a pharmacist and affiliate faculty member at Oregon State University and chair of the Oregon Pain Management Commission. Her findings and comments appear in recent issues of the Journal of Pain and Palliative Care Pharmacotherapy and in The Rx Consultant.

Hahn argues that the failure to adequately treat pain associated with a variety of medical problems can be linked to physicians’ personal biases, inadequate training in pain management, and fear of prescription drug abuse. These hurdles need to be overcome, as Hahn says the situation is reaching “crisis proportions.”

The National Center for Health Statistics reports that 76.2 million Americans suffer with chronic pain. The American Academy of Pain Medicine notes that the most common types of pain include arthritis, lower back, bone/joint pain, muscle pain, and fibromyalgia.

A 2006 survey conducted for the American Pain Foundation and sponsored by Endo Pharmaceuticals found that among chronic pain sufferers who were currently taking an opioid, more than half felt they had little or no control over their pain, 59 percent said it had an impact on their overall enjoyment of life, 77 percent were depressed, and 86 percent could not sleep well.

Despite the epidemic of chronic pain, Hahn notes that pain treatment is not a major part of medical school training, and in fact medical students may receive only a few hours of instruction on the use of opioids. Even though physicians have sophisticated pain management methods available, “many doctors are not fully informed about all the options available,” explains Hahn, “and also often turn patients away because they’re very concerned about the problems with prescription drug abuse.”

It’s not that the prescription drug abuse problem isn’t real: drugs such as oxycodone and morphine are often stolen and misused. A 2006 survey of teenagers found that 62 percent said they could easily get prescription pain relievers from their parents’ homes, and another study reported that admissions to federally supported treatment programs for opioid abuse increased 342 percent between 1996 and 2006, at a cost of tens of billions of dollars annually.

Although undertreatment of pain can affect people of any age, Hahn says that “It’s particularly bad with elderly and Medicare patients.” She added that long-term solutions that address both adequate pain management and prescription drug abuse will require education and cooperation from consumers and healthcare providers. Some suggestions include:

Patients need to cooperate with their healthcare practitioners regarding their pain management plans that may include prescription drugs as well as exercise, meditation, massage, physical therapy, and other approaches.

  • Consumers need to lock up any prescription drugs they have in their home to prevent theft and misuse
  • Both healthcare providers and consumers need to understand that psychological addiction or physical dependence on drugs is rarely a significant problem when patients are in a prescribed pain management program that is managed properly
  • Physicians need to stay current on the latest options in pain management and recognize that pain control is a major part of overall health care
  • Patients in chronic pain need to be persistent in ensuring their pain concerns are taken seriously by healthcare providers

Hahn also notes that health insurers “can help educate physicians on appropriate use, advocate for universal precautions in use of pain medicines,” and that community pharmacists can help educate patients who live with chronic pain and help them manage their prescribed drug therapies.

SOURCES:
American Academy of Pain Medicine
American Pain Foundation
Hahn KL. Journal of Pain and Palliative Care Pharmacotherapy 2009; 23(4): 414-18
National Centers for Health Statistics
Oregon State University press release

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