Pain Patients Treated by ‘Dysfunctional’ Health Care System

Pain Patients Treated by ‘Dysfunctional’ Health Care System

An independent panel convened by the National Institutes of Health (NIH) has concluded that individualized patient care is needed to better treat the estimated 100 million Americans who suffer from chronic pain. The panel recommends more research and development of multidisciplinary treatments for pain patients, who are being treated by a “dysfunctional” health care system.

“Persons living with chronic pain have often been grouped into a single category, and treatment approaches have been generalized with little evidence to support this practice. Chronic pain spans a multitude of conditions, presents in different ways, and requires an individualized, multifaceted approach.,” said David Reuben, MD, panel chair and professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

“We have inadequate knowledge about treating various types of pain and how to balance effectiveness with potential harms. We also have a dysfunctional health care delivery system that promotes the easiest rather than the best approach to addressing pain.”

bigstock-healthcare-medical-and-future-50084171In September, 2014 the NIH held a workshop, “The Role of Opioids in the Treatment of Chronic Pain,” that included a panel of 7 experts and featured more than 20 speakers.

In a subsequent review the panel looked at the long-term effectiveness of opioids, the safety and harm of opioids, the effects of different opioid management strategies, and the effectiveness of risk mitigation strategies.

A summary of the panel’s final report was published this week in the Annals of Internal Medicine.

As in previous government studies, the panel used the term “epidemic” to describe the increased use of opioids, which has led to a “striking increase” in overdoses and treatment for addiction to prescription painkillers.

But the panel also made an effort to address issues from a patient perspective.

“Health care providers, who are often poorly trained in the management of chronic pain, are sometimes quick to label patients as ‘drug-seeking’ or as ‘addicts’ who overestimate their pain. Some physicians ‘fire’ patients for increasing their dose or for merely voicing concerns about their pain management. These experiences may make patients feel stigmatized or feel as if others view them as criminals and may heighten fears that their pain-relieving medications will be taken away,” the report states.

The panel found evidence that 40% to 70% of patients with chronic pain do not receive proper medical treatment, with many being over treated or undertreated. It estimated that about 5 to 8 million Americans use opioids for long-term pain management, although there is “scant” evidence on the safety and effectiveness of long-term opioid use.

Also lacking, according to the panel, is evidence about the value of many risk mitigation strategies, including patient contracts, urine drug screening, and pill counts.

“Clearly, there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches,” said Reuben. “The challenge is to identify the conditions for which opioid use is most appropriate, the alternatives for those who are unlikely to benefit from opioids, and the best approach to ensuring that every patient’s individual needs are met by a patient-centered health care system.”

The panel identified several barriers to implementing patient-centered care. Many physicians don’t have the tools or the training to assess patient measures of pain, quality of life, and adverse outcomes. Many insurance plans also don’t cover nonpharmacologic options, such as physical therapy, behavioral therapy, and complementary and alternative medicine. In addition, some plans do not offer effective non-opioid drugs as a first-line treatment for chronic pain, which limits a doctor’s ability to explore other avenues of treatment.

To address knowledge gaps, the panel cited a need for more research on pain, multidisciplinary pain interventions, the long-term effectiveness and safety of opioids, as well as opioid management and risk mitigation strategies. The panel also recommended the use of electronic health databases to help healthcare providers make pain management decisions.

Authored by: Pat Anson, Editor

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Brenda Alice

I am one that has required narcotics for at least 10 plus years. They do not take away the pain completely but DO allow me to live a very limited life. I would be interested in how those 10% are actually doing. Are they like me who gave up the grandkids ballgames when my medication was cut 1/3 to make the DEA happy? I have tried alternative methods for pain relief without success. I have no cure for my conditions, just managing the symptoms. It’s a shame that people have allowed the right to be pain free to be taken from us. There is a great educational and touching 3 part clip on pharmacist Steve’s blog about the persecution of the chronic ill.
We also have the petition athttp://www.thepetitionsite.com/takeaction/891/682/672/. Please watch that clip, most meaningful to me in months. And Thank you Dr. Ibsen for helping your patients. God will have a special place for your compassion.

Louis Ogden

Sarah said “Louis – I’m glad you have found relief and a reason to live through proper medication. . . sounds like you have a good doctor. They can be hard to find.”

I have a GREAT doctor, Dr. Forest Tennant (see:
http://www.foresttennant.com/index.html). His website is tremendous and packed with good info. He’s also the editor of “Practical Pain Management,” a medical journal devoted to chronic pain.

The downside – I live in Virginia and his practice is in West Covina, California. I see him every 90 days but fortunately have a supportive family and in-laws that have given financial help.

Sarah Rohrs

Louis – I’m glad you have found relief and a reason to live through proper medication. I, too, hope the focus of pain management does not become weaning people off of drugs that help them obtain a quality of life. I think most people have no idea what it’s like to live in constant pain, or to try to care for and live with someone battling this. Sounds like you have a good doctor. They can be hard to find.

Louis Ogden

Mark, why do you want to wean everyone? It is the only therapy that has lowered my pain. You say “What is to be done about patients who’ve been on moderate to high does opiates on a daily basis for one, three or 10 years?” I hope nothing if they are doing well! Opioid therapy has changed my life to one where I have a reason to live instead of non-stop suicidal ideation.

Louis Ogden

Very well said, Sarah! Although I am doing very well and my pain is controlled, every time I see a new doctor their goal is always “we have to get you off these pain meds.” Why in the &%#@ they want to do that defies logic? I guess I should try homeopathy or aromatherapy – long time coming! Once again, excellent post!

Louis Ogden

Another point I left out. I wanted to try a different approach (dry needling) that did not end up working out. The doctor required me to be free of opioids to see what was helping. I had no difficulty weaning myself slowly off the meds. I titrated downward in small increments and had no problem doing so.

Louis Ogden

I’ve been on ultra-high dose opioids for almost five years after trying many treatments. Opioids are not the first line of treatment but when needed, they can be life savers. I am 65, have lived with terrible pain in childhood thru present. My first diagnosis was fibromyalgia but now the diagnosis is Centralized Chronic Pain. I now am having the highest quality of life I’ve ever had.

Mark Ibsen

The Pain expert hired by the board of medicine in my state, a fellow member of my state medical society, testified against me. I have been able to wean many patients who came to my Urgent Care in distress. While he criticized my care, he also noted that in HIS hands 10% of patients are able to complete merely wean off opiates. He also noted:The longer a person is on opiates the less likely they are to be able to completely wean off them.
So
What is to be done about patients who’ve been on moderate to high does opiates on a daily basis for one, three or 10 years?