Chronic pain should be recognized as a disease, not a symptom, according to a panel of experts that testified before a U.S. Senate committee Tuesday. It was the first congressional hearing ever held on chronic pain and pain management, a public health issue that’s drawing increasing attention in the medical community.
An estimated 116 million Americans suffer from acute or chronic pain, at an annual cost of $635 billion in medical treatment and lost productivity, according to a landmark study in 2011 by the Institute of Medicine.
“From the moment I open my eyes every morning, the first thing I feel is pain. And it stays with me throughout the day,” testified Christin Veasley, who suffers from back pain, facial pain and migraines caused by a near fatal accident 20 years ago.
Like many chronic pain sufferers, Veasley is frustrated with how the medical and health insurance industries deal with pain. In the last few years, Veasley said she has visited doctors in four different states and tried 15 different treatments, many paid for out of her own pocket. Yet she still lives in pain.
“As patients we are completely disillusioned, forced to navigate the health care system on our own and implement a trial and error process that can easily take months to years to find a treatment to lessen the pain that we experience,” said Veasley, who is a pain management advocate and executive director of the National Vulvodynia Association.
Sen. Tom Harkin (D-Iowa) chaired the meeting of the Senate Committee on Health, Education, Labor & Pensions to draw attention to what he called an “epidemic” of chronic pain.
“Chronic pain is a significant public health challenge that has yet to receive adequate attention given the tremendous impact it has on people all across our nation,” Harkin said. “Chronic pain remains one of the most challenging conditions to assess and effectively treat even though its one of the top reasons for doctors visits.”
Harkin said there was a lack of coordination in federal agencies like the National Institutes of Health (NIH) in addressing chronic pain. He also believes the nation’s doctors are being poorly prepared to deal with the challenges of treating chronic pain.
“We need to do a better a job of educating in medical schools and in our residencies about the different forms of pain and how they should be treated,” Harkin urged. “How do we educate our doctors to understand this and make the right kind of diagnosis?”
One solution is to start treating chronic pain as a disease, testified Lawrence Tabak, DDS, PhD, the principal deputy director of the NIH. Tabak and other pain experts called for a “cultural transformation” in how the nation understands and approaches pain management.
“Perhaps the most important modern insight about chronic pain is that chronic pain, no matter how it begins, can become a disease in and of itself,” said Tabak. “Changes in the brain and elsewhere in the nervous system can cause pain to persist long after it has any adaptive value. This recognition of chronic pain as a disease has important implications for how we study pain, treat pain and structure our health care to provide care to patients suffering from pain.”
Tamak said the number of people suffering from chronic pain is likely to grow because the U.S. population is getting older, which results in more people suffering from age-related diseases such as arthritis. Improving survival rates from heart disease, cancer, stroke and HIV/AIDS also contributes to the number of chronic pain sufferers.
There are not enough trained doctors to treat chronic pain, according to Philip Pizzo, MD, dean of Stanford University’s School of Medicine and co-author of the Institute of Medicine’s report on pain. Pizzo said the current number of 4,000 pain specialists in the U.S. was “not nearly enough.”
“The scope of the problem in pain management is truly daunting. And the limitation and knowledge of pain health care professionals is glaring,” Pizzo testified. “The medical community must actively engage in the necessary cultural transformation to reduce pain suffering of Americans.”