Blog — Nicolas Argy, MD, JD

face-1190352 The British medical journal recently published an article (1), revealing the staggering incidence of chronic pain in the population. The estimate was that 43% of adults in the UK have chronic pain. The percentage of the population with pain steadily increases with age and at age 75, 62% of people had chronic pain. Current estimates show that $600 billion is spent annually on pain management in the US alone. (2) With over 10,000 people in the US reaching the age of 65 daily, the baby boomers will create a huge challenge to manage chronic pain.

The enormous reluctance to prescribe narcotics due to the crisis of narcotic abuse portends a looming crisis. Renewed efforts to research novel approaches to chronic pain and very importantly train caregivers in the host of techniques both traditional and nontraditional which give patients relief will be needed. Our attitude and expectations for ourselves and patients regarding reaching an acceptable level of discomfort must be assessed.

Retraining caregivers in attitudes, management and communication of issues in pain has been suggested. Experts in pain management will take the lead in both educating and acting as the vanguard for more effective interventions which look at all options including physical therapy, mindfulness, meditation, cognitive behavioral therapy, biofeedback, acupuncture, massage, aromatherapy and others.

The comprehensive 382 page work of the IOM on Relieving Pain in America (3) provides a blueprint for addressing the issue.

RELIEVING PAIN IN AMERICA: UNDERLYING PRINCIPLES GUIDING THE IOM COMMITTEE.

Effective pain management is a moral imperative, a professional responsibility, and the duty of people in the healing professions.
Chronic pain has a distinct pathologic basis, causing changes throughout the nervous system that often worsen over time. It has significant psychological and cognitive correlates and can constitute a serious, separate disease entity.
Pain results from a combination of biologic, psychological, and social factors and often requires comprehensive approaches to prevention and management.
Given chronic pain's diverse effects, interdisciplinary assessment and treatment may produce the best results for people with the most severe and persistent pain problems.
Chronic pain has such severe effects on all aspects of a person's life that every effort should be made to achieve both primary prevention (e.g., surgery) and secondary prevention (of the transition from the acute to the chronic state) through early intervention.
Although there is much more to be learned about pain and its treatment, even existing knowledge is not always used effectively, and thus substantial numbers of people suffer unnecessarily.
The committee recognizes the serious problem of diversion and abuse of opioid drugs and questions about their long-term usefulness; it believes, however, that when opioids are used as prescribed and are appropriately monitored, they can be safe and effective, especially for acute, postoperative pain, procedural pain, and patients near the end of life who desire more pain relief.
The effectiveness of pain treatments depends greatly on the strength of the clinician–patient relationship; pain treatment is never about the clinician's intervention alone, but about the clinician and the patient (and family) working together.
Many features of the problem of pain demand public health approaches — the large numbers of people affected, disparities in occurrence and treatment, and the goals of prevention. Public education can counter myths, stereotypes, and stigma that hinder better care

On a personal note having had two major spinal fusions, having pain continually and being disabled, the importance of staying mentally active and involved with family, friends and professional activities may provide one of the best tools to mitigate chronic pain.

One of the most startling aspects of the discussion of the incidence and treatment of chronic pain is the paucity of initiatives to prevent the chronic conditions which lead to untold suffering. We need to redouble efforts to minimize the damage from smoking and alcohol, to use diet and exercise interventions to not only reduce arthritis, obesity and diabetes but also decrease the incidence of cancer. Creating policies which address the social determinants of health including health literacy, economic disparities, housing and environmental hazards must be initiated. Patient engagement is a common denominator for moving all these agenda items forward.

One extremely vulnerable population whom we should not forget are those who are near end of life and are suffering. Caregivers need to use all means including generous administration of narcotics to insure patient’s end of life experience is pain free.

The heralded successes of increased longevity have associated consequences for which we must prepare. By using a multidisciplinary approach to pain, pain management combined with patient engagement, we can be most effective in addressing the discomfort that a large majority of us will be feeling. Prevention will always remain the gold standard, the best intervention, to enhance public health and alleviate suffering.

Please see subsequent update, http://bit.ly/28YmYns

dad round circle pic

Nicolas Argy, MD, JD

References