Somewhere between 50 and 115 million Americans are dealing with persistent chronic pain according to Stanford and Harvard research centers and the Centers for Disease Control and Prevention. This represents 25-30% of the total population of the United States. It’s a shocking number by any means. Hard numbers aren’t easy to come by, but two surveys, one done in 1998 and one done in 2004 indicate that most of those patients don’t get adequate relief from their pain with the current pain management models. This includes diagnosis of Fibromyalgia, Chronic Fatigue Syndrome, Peripheral Neuropathies, neurological and tremor disorders, Celiac, IBS, musculoskeletal pain (whiplash, chronic degenerative disease, herniated discs, scoliosis, joint pain) and more.
So the next question has to be why? American’s supposedly enjoy one of the most advanced (if flawed) health care systems in the world and with nearly 1/4 of us hurting regularly, it’s not as if pain is an unusual phenomenon. In fact it could hardly be more common. Persistent pain affects more people than heart disease, cancer, and diabetes combined. Not surprisingly it’s also the number one reason we see a doctor or head for a hospital.
In my opinion as one who treats chronic pain symptoms on a daily basis there are several reasons. Among them the main reason that chronic pain is undertreated is that most chronic pain syndromes are multifactorial which is contradictory to the current symptom based primary drug/surgical medical model. Secondary is poor doctor training in the chronic pain model. Time elements and duration of pain are influences. Insurance coverage – or lack thereof – is also a factor.
Let’s discuss these contributors in further detail.
“Doctors are so undertrained in treating chronic pain” says Scott Fishman M.D., chief of pain medicine at the University of California at Davis “that we just have not done as well in quality of life as we’ve done in quantity of life”. In fact most medical students receive no more than a few hours of pain training during their studies. One survey by John’s Hopkins researchers found that only 3 of 126 US medical schools require courses in pain, while 33 schools have required classes that contain sessions – an average of just 5 dealing with the topic. And none of these courses address non-drug approaches to the problem. None. So if you’re seeing a primary physician, as most people do with chronic pain, you should assume that he/she probably didn’t get a lot of schooling in what ails you. The upshot is that your doctor, however well intentioned, may not know how to help you if your pain persists. Remember – he/she is schooled in acute pain only and may only rely on a limited arsenal of pain medications – frequently the ones allowed by your insurance provider. In the end many of the primary doctors treating pain simply aren’t armed educationally or clinically with the latest information on how serious a problem untreated pain can be or the newer cutting edge, non-drug technologies to control it.
Then there is the time element – pain if left untreated or, ineffectively treated, causes your aches and pains to become more severe and become even harder to get under control, especially for primary care doctors who see 30-40 patients a day. There’s no way you can expect a proper diagnosis of a complex pain problem in an 8, 10, or 12 minute visit.
Insurance – Even if you are lucky enough to have health coverage it doesn’t mean you’re going to get the treatment you need for your specific pain condition. With 50-115 million chronic pain patients in this country and with them being unsuccessfully treated in a largely symptomatic acute pain model addressed by drugs and surgery – it’s obvious something is not working. It’s stunning that the insurance industry will continue to support and subsidize failed treatment models for chronic pain when the failed model is exactly what is crushing the entire health care industry. The costs of untreated or poorly treated chronic pain are what’s causing the dramatic rise in health care costs, yet resistance of insurance companies in covering new and successful non-drug treatments is perpetuating the problem.
The new paradigms – “It wasn’t too long ago that pain was considered a psychological problem” says Gallagher, MD the director of pain policy research and primary care at Penn Pain Medicine and clinical professor of psychiatry and anesthesiology at the University of Pennsylvania, in Philadelphia. In other words, intractable pain was once thought by scientists to be all in your head. New scientists understand that “chronic pain” can be a real disease process or malfunction in the central nervous system (brain and spinal cord). Pain can thus become a chronic disease in and of itself. And it is multifactorial – in other words there are many other conditions that the patient has, but probably doesn’t realize are affecting the brain and nervous system to create their unique set of pain symptoms. The problem becomes that if your doctor isn’t aware of the most current thinking (and most are not – remember the few hours of training) about your condition and about pain in general, there’s a real probability you will never receive effective treatment. And if he or she did recommend what is currently considered to be effective treatment it will often be considered a non-covered service by your insurance company because many of the more advanced treatment options relative to the current understandings of chronic pain related to the brain and metabolic abnormalities are considered experimental and not medically necessary treatment options. This is a severe dilemma for many patients seeking relief outside of drugs or surgeries. Especially because the new technologies work.
To be fair to the acute medical model too many of us in this country have adopted a “pop a pill” mentality. If only treating chronic pain were as simple as taking a medication, herb, botanical, or vitamin. All of these do help to a degree in many cases, but typically they are not ever the magic bullet. Chronic pain is a complex condition composed of metabolic, neurologic, inflammatory, endocrine, autoimmune processes, and more. Drug and herb therapies are at best a valuable component of an overall approach to addressing the true causes of the pain symptoms and effecting “a cure” or a non-drug pain patient centered protocol for effective pain management.
All of the evidence to date, and we have profoundly had to come to this conclusion in our offices at Power Health, is that a multi-disciplinary approach to pain works best. It takes a team. That team might include at our offices a functional medicine doctor to assess the multiple systems approach – now acknowledged in the science to be the most effective model to address chronic systematic pain utilizing the latest cutting edge testing and non-drug approaches. Functional Neurology evaluates the nervous system in its entirety – both central and peripheral nervous system, to determine the extent of its involvement with the patient’s pain presentation. The musculoskeletal aspects of chronic pain are addressed through chiropractic and physiotherapy evaluations and protocols. An osteopath, O.D., addresses the more acute medical needs and currently we are exploring bringing a stress management practitioner on board as overwhelming stress can be a deal breaker in chronic pain management.
This is our model. It encompasses an attack on pain on multiple fronts: diet, nutrition, exercise, rehab, relaxation, lifestyle modification, but most importantly it addresses the most under-appreciated brain, nervous system and autoimmune aspects of chronic pain with no or minimal drug intervention.
There are many ways to go; physical therapy, massage, yoga, acupuncture, biofeedback, and more. The question is what combination is right for the patient. So I would add that to find out requires a procedure that consists of a comprehensive history, comprehensive neurological, metabolic and musculoskeletal exams, and an organized team that is willing to work together in an organized approach, based on what that patient’s specific exam and test findings indicate to be the most appropriate modalities for that patient. There should be no second guessing. That does not happen in an 8, 10, 12 minute medical model acute pain patient visit. It doesn’t happen when multiple physicians and therapists are involved, but not coordinating their treatment protocols and not communicating with each other on what’s best for the patient. That doesn’t happen when insurance companies dictate care using outmoded and outdated treatment protocols that do not include multidisciplinary approaches. This is why 50-115 million chronic pain patients are suffering and crushing the current health care system. And until we change to the new scientifically established brain based, metabolically based cooperative multidisciplinary model the numbers of chronic pain patients will continue to rise.
If you’re a chronic pain patient this is your dilemma. I hope this article helps. There are solutions. You can stop the downward pain spiral and extract yourself from the 50-115 million chronic pain sufferers if you embrace the above model. Good luck in your journey.
Pain Resource – Magazine – Fall 2012 Jaquline Stenson author
Power Health – Back to Basics – Rutherford, Martin 2002, 2003 Printed in USA Bloomington Ind.