Faculty Perspectives in Chronic Pain, Part 1 of 5
Addressing the Socioeconomic Burden of Chronic Pain
The main article in this publication highlights the rising incidence of chronic pain that afflicts 43% of the adult US population (as of 2010).1 In addition, the author discusses the disparities that exist in terms of pain assessment and treatment for several disadvantaged groups, including the elderly, women, ethnic/racial minorities, and Americans with low incomes.1 On an individual level, patients with chronic pain experience a significant impact on their quality of life, as measured by their limited daily activities, work, and social relationships.2 In addition, the degree of comorbid emotional distress and psychiatric medical conditions among patients with chronic pain is staggering.3 This emotional distress may precede or result from chronic pain, and the concurrent treatment of these coexisting conditions is paramount to the interdisciplinary management of patients with pain.4,5
Although chronic pain may result in unemployment, early retirement, and disability, the negative effects of this condition may also lead to psychological distress that ripples through relationships with family and friends.1 It is evident that chronic pain results in a broad societal burden, and there is a significant need to educate the public, healthcare providers, patients, and policy makers regarding the socioeconomic burden of chronic pain, as well as effective assessment and treatment strategies.
Given the incremental increase in healthcare expenditures that correlates with increasing pain severity, resources to appropriately manage chronic pain conditions could reduce the staggering $635 billion in annual costs.1 Based on the optimal interdisciplinary approach to pain medicine, these resources must be delegated to not only increase awareness among the public, providers, patients, and stakeholders, but to also provide appropriate access to treatment—spanning medications, interventions, physical therapy, occupational therapy, and mental health services.
One significant component to reduce the gap between the socioeconomic burden of pain and the assessment and treatment of patients with chronic pain revolves around education, as emphasized in the Institute of Medicine report on Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.1 Patient education programs can directly improve function and reduce pain. In addition, public education programs on pain have the potential to prevent symptom onset, improve patient advocacy for pain treatment, increase awareness of existing resources, and advocate for additional preventive measures. Educational topics may focus on self-management, the optimal use of emergency and urgent care resources, the role of different healthcare providers in pain treatment, risks and benefits of various pain medications, and the biopsychosocial dimensions of pain.1
A particularly important educational topic should center on opioid misuse, abuse, and diversion. Healthcare practitioners must be educated to appropriately assess the risks associated with opioid use, while balancing the need to prescribe these medications to treat patients with chronic pain.1 Furthermore, healthcare provider education should emphasize interdisciplinary collaborations among pain specialists and primary care practitioners.1
The socioeconomic burden of chronic pain is likely to magnify over time, but measures can be taken to improve the timely assessment and treatment of patients with this condition—primarily through education and increased resources.
- Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011. http://books.nap.edu/openbook.php?record_id=13172&page=17. Accessed December 16, 2014.
- Nolet PS, Kristman VL, CÃ´tÃ© P, et al. Is low back pain associated with worse health-related quality of life 6 months later? Eur Spine J. 2014 Nov 13. Epub ahead of print.
- McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain. 2003;106:127-133.
- Gureje O. Psychiatric aspects of pain. Curr Opin Psychiatry. 2007;20:42-46.
- Lin EH, Katon W, Von Korff M, et al. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA. 2003;290:2428-2429.
The Socioeconomic Burden of Patients with Chronic Pain
Managed care organizations (MCOs) must play a pivotal role in the management of patients with chronic pain. Payers already recognize that pain is one of the most prevalent chronic conditions and that it is generally associated with significant comorbidities. As noted in the main article in this publication, there may [ Read More ]
Reducing the Negative Effects of Opioids While Adequately Managing Pain
Practitioners, healthcare providers, governing bodies, and patients all agree that there are significant gaps in the adequate management of pain in our current healthcare system. In addition, there are great concerns among practitioners regarding the social effects of ramping up opioid use for the management of chronic pain. These concerns [ Read More ]