America Is Losing the War on Chronic Pain

Written by Anna Wahrman with additional reporting by Whitney Akers on November 9, 2017

In the face of an escalating opioid crisis, at least 100 million people with chronic pain aren’t getting the relief they need and are seeking alternatives.

More than 30 percent of Americans are living with some form of chronic or severe pain. More people live with chronic pain than cancer, heart disease, and diabetes combined, for a total of between 100 million and 116 million people.

Simultaneously, opioid addiction and overdose rates have skyrocketed, becoming a full-fledged public health emergency.

Despite this, one-third of the country is still in pain, and most aren’t getting the relief they need — from opioids or any other form of treatment, two Healthline surveys found.

Because of some healthcare workers’ attitudes toward opioids and media coverage of the opioid epidemic, when patients bring up the fact that they live with pain, they’re looked at with skepticism, questioned relentlessly, second-guessed, and judged.

“A lot of people can’t even conceptualize what being in horrible pain every minute of your life feels like,” Shelley Smith, who lives with fibromyalgia and blogs at Chronic Mom, told Healthline.

Pain advocates like Cindy Steinberg, the national director of policy and advocacy at the U.S. Pain Foundation and chair of the Policy Council of the Massachusetts Pain Initiative, are working to correct the narrative of pain patients as potential addicts.

She believes that pain treatment is complex and said that the media’s coverage of the opioid epidemic harms people who truly live with pain.

The opioid crisis “grabs headlines. It’s juicy,” Steinberg told Healthline. “So the media flocks to this topic, and politicians love grandstanding about it. They don’t understand the nuance or the complexity of this issue.”

Smith has also seen this firsthand. “There’s not a lot in the media about chronic pain patients. It’s all about addiction and people abusing their pills. But there are pain patients suffering long term and they can’t get any help from the medical community,” she explained. “No one is willing to listen to them.”

The drivers behind the opioid epidemic

There’s no question that the use of opioid medications in the United States is a dangerous and mounting problem.

In 2015, opioid overdoses killed approximatelyTrusted Source33,000 people, up from around 11,000 10 years prior.

Opioid abuse has been called the deadliest drug epidemic in U.S. history.

But the epidemic is driven primarily by illegal — not medical — abuse of prescription pills.

A studyTrusted Source of over 135,000 opioid overdose victims found that just 13 percent were chronic pain patients.

Still, pain patients bear an inflated burden of the backlash against opioid use, which was driven by the pharmaceutical industry in the 90s.

Opioid prescriptions picked up in 1995 with Purdue Pharma’s introduction of OxyContin to the market, Annual Review of Public Health reported.

“Between 1996 and 2002,” the journal noted, Purdue “funded more than 20,000 pain-related educational programs through direct sponsorship or financial grants and launched a multifaceted campaign to encourage long-term use of [opioids] for chronic non-cancer pain.”

In 2007, Purdue “pleaded guilty to federal charges that they misled doctors and patients” and paid more than $600 million in fines.

But Purdue wasn’t the only drug manufacturer peddling opioids — which also include Vicodin and Percocet — without mentioning the potential for abuse.

The pharmaceutical industry’s aggressive marketing of opioids led to a quadrupling of such prescriptions between 1999 and 2010.

A Washington Post and 60 Minutes investigationalso found evidence that pharmaceutical companies helped shape and lobby for a law passed by Congress that undermines the Drug Enforcement Administration’s (DEA) authority to stop opioids from flooding into the market.

From extreme marketing of opioids to President Trump declaring the opioid epidemic a “public health emergency” — this reflects a drastic change in the attitudes around prescription pain medication.

Dr. Susan Glod, in a commentary in the New England Journal of Medicine, wrote that the vilification of pain patients “is the result of an all-or-nothing approach to pain management under which the pendulum has swung from one unsustainable end of the spectrum to the other in the past two decades.”

Indeed, doctors wrote 259 millionTrusted Source prescriptions for painkillers in 2012. More than one in three Americans were prescribed an opioid in 2015Trusted Source.

The CDC reportedTrusted Source that nearly half of overdoses in 2015 involved a prescription opioid and thatTrusted Source“sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there has not been an overall change in the amount of pain Americans report.”

Opioids are often getting into the hands of people who don’t have pain, and opioids don’t eliminate the pain for many people with chronic pain.

There’s no doubt that opioid addiction is a real public health crisis.

But Caitlin Carroll, a spokeswoman for the Pharmaceutical Research and Manufacturers of America (PhRMA), an advocacy group for biopharmaceutical research companies, also pointed out that there are “legitimate patient needs that exist.”

“Any policy that we consider should balance the need to help prevent prescription drug abuse and misuse while still balancing the millions of Americans who deal with acute and chronic pain.”

The chronic pain epidemic goes ignored

A Healthline survey of nearly 600 readers with chronic and severe pain revealed that 36 percent of people are dissatisfied with their pain medication. Only 5 percent reported that their medication totally resolved their pain while 50 percent got some relief — but 45 percent said it wasn’t enough or didn’t help at all.

A separate survey of 249 Healthline readers with acute knee pain showed that though just over half had taken a prescription pain medication, only 4 percent reported that such medication totally treated their pain. Fifty-two percent said their medication wasn’t enough to resolve their pain, and 44 percent reported that it helped somewhat.

The majority of pain patients who take opioids don’t get full relief, but they do get side effects — and plenty of them. The most reported physical side effect is constipation.

More than half (56 percent) of Healthline’s chronic pain survey respondents reported constipation, 25 percent experienced nausea and vomiting, and another 25 percent felt anxious.

These side effects can cause even more pain for people living with chronic pain, too.

Lynn Crisci was at a nearby cafe on the day of the Boston Marathon bombing when the explosion went off, jarring her brain and leaving her with a traumatic brain injury (TBI), a chronic lower back injury, hearing loss, and PTSD. She deals with horrible pain daily from that TBI, plus a previous TBI from an accident.

Crisci told Healthline that not only did opioids bring on brain fog — already an issue with her TBIs — but caused serious constipation. Focused on treating her pain, her doctors didn’t treat the medication’s side effects.

Crisci ended up with multiple organ prolapse, requiring several surgeries.

“My digestive system will never be the same,” Crisci told Healthline. “I’m in pain from scar tissue pressing on nerve endings in my colon. Opioids have done irreparable harm to me.”

Opioids can be powerful treatments for many chronic pain patients, though. Smith used to be an avid hiker, frequently immersing herself in nature on 10-mile hikes.

When she began experiencing fibromyalgia after the birth of her second child, she could hardly get out of bed at times — let alone enjoy nature. The pain was so overwhelming.

“I’ll never go back to how much I used to do, but once I actually got access to pain medication, I was able to take a family vacation to Yellowstone and can go on one- to two-mile hikes with my kids. My pain level is really high afterward, but I can do it because I have pain medication,” she explained. “I feel lucky to get a little piece of my life back.”

So if clinicalTrusted Source and anecdotal evidence shows that pain medication is only moderately beneficial in treating chronic pain and causes unwelcome side effects, why do doctors persist in prescribing them, and why do patients persist in taking them — when they can actually get them?

The short answer: Neither doctors nor patients have a lot of other choices that work significantly better. The longer answer: Individualized care, which pain experts agree is the best courseTrusted Source in pain treatment, takes much more effort and knowledge than most doctors are able to provide in the limited amount of time they have for evaluation. And it often costs more than health insurance companies would like to spend.

The blame game

In terms of time, stories of doctors not having time to listen to patients’ complaints beyond the cursory are legend. They cram in as many patients as they can — a 2013 study found new doctors spent eight minutes with each patient — submit as many insurance claims as possible, and then they drown in paperworkTrusted Source. Doctors say it’s not that they don’t want to listen to patients, it’s that they can’t afford to.

In terms of knowledge, the Journal of Pain reportedTrusted Source in 2011 that pain education among U.S. physicians was “limited and fragmentary.” Medical schools in the United States require only nine hours-worth of learning on pain management. By comparison, some veterinary students spend five times as many education hours focused on pain management, according to one expert.

Crisci, who is the Massachusetts Ambassador for the U.S. Pain Foundation and director of Medical Marijuana Advocacy for Leaftopia, said that one of the main factors for the mistreatment of chronic pain patients is the way doctors are educated.

“There’s very little to no training in chronic pain treatment, but doctors are taught to look for signs of addiction. People who ask for pain medication are assumed guilty until they’re proven innocent,” she pointed out. “You feel like you’re on trial.”

PhRMA’s Carroll, too, pointed a finger at physician education, saying her organization advocates for “mandatory prescriber education — increasing it, and making sure that it’s ongoing and that it reflects the growing body of information that we have about pain management and about the risks of addition.”

In defense of the education doctors receive regarding pain management, Patrice Harris, MD, immediate past chair of the American Medical Association (AMA) as well as the chairwoman of the group’s AMA Opioid Task Force, said that it’s part of a physician’s job to maintain competency that’s relevant to their practice.

Harris suggested that insurance companies may be a potential source of blame. The rules around insurance are byzantine, varying from provider to provider and state to state.

There are any numberTrusted Source of provider and patient variables, muddying the waters on costs — copays, deductibles, coinsurance — and benefits significantly.

But it’s safe to say that insurers favor drug therapy, and a copay for medication can be less than that of a visit to a physical therapist.

“Perhaps the physician wanted to recommend physical therapy, but there may be a higher copay, and there are usually limits” to the number of visits the patient can have, said Harris.

Physical therapy, when covered, has been shown to be extremely effectiveTrusted Source. But pharmaceutical companies don’t recoup their costs from physical therapy and other alternative treatments.

They spend millions researching drugs and lobbying for them to earn FDA approval.

They spend additional money on marketing directly to doctors via sales representatives and conferences.

But inarguably, it’s faster for a doctor to get a patient out of the office by dispensing a prescription or refusing to provide treatment than it is to discuss complex treatments for complex topics like pain.

There’s no doubt that navigating insurance requirements can be arduous

So, while the government mulls action, policy makers stumble toward potential solutions, and the healthcare community points fingers over who started the opioid crisis, pain sufferers are caught in the middle, desperate to find relief and willing to try almost anything to get it.

“Beyond not being treated, the chronic pain community is being mistreated by being stigmatized,” Crisci stressed.

“Their families are told that they’re acting out for attention, that they need mental help, that the pain is all in their heads. It kills the foundation of their support system and makes recovery even more difficult,” Crisci said.

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LINK TO ORIGINAL ARTICLE: https://www.healthline.com/health-news/america-is-losing-the-war-on-chronic-pain#17

TAGS: Chronic Pain, Opioid, prescription pain medication, CBD, FDA, New England Journal of Medicine