A major new public health campaign is needed in the U.S. to battle an “epidemic” of chronic pain, according to a report published in the New England Journal of Medicine.
“The magnitude of pain in the United States is astounding,” wrote the authors of the perspective piece, Philip Pizzo, MD, dean of the Stanford University School of Medicine, and Noreen Clark, PhD, professor of health at the University of Michigan. More than 116 million Americans suffer from chronic or acute pain, according to a recent report by a committee of the Institute of Medicine. Pizzo and Clark were chairs on the committee.
Annual expenditures related to pain, including direct medical costs and lost wages, is estimated at $560 to $635 billion a year. Pizzo and Clark called pain a major, overlooked medical problem in the U.S. that requires improved education at multiple levels, including better training of physicians in pain management.
“Sadly, many physicians are viewed as ‘poor listeners’ by people living with chronic pain,” said Pizzo, who is also a professor of pediatrics, microbiology and immunology. “Some physicians over-prescribe medications including opioids, while others refuse to prescribe them at all for fear of violating local or state regulations. Many people with chronic pain simply don’t know where to go for help.”
A major impediment to pain relief is limited access to doctors who are knowledgeable about acute and chronic pain. Fewer than 4,000 pain specialists are currently practicing in the U.S. A recent survey of 117 medical schools by Johns Hopkins University found that most provided only a few core topics on pain; with cancer pain, pediatric pain and geriatric pain essentially ignored by most medical schools. Other studies have found that most primary care physicians feel “inadequately prepared” to counsel patients on pain.
“Often, an initially supportive community becomes intolerant or inattentive as the pain persists, which leads many people with chronic pain to give up, resulting in depression,” the authors wrote. The public attitude toward chronic pain also sends the message that pain sufferers need to “just suck it up.”
Pizzo and Clark called for public education campaigns, along with targeted efforts to educate patients themselves, to help patients and their families find the help they need. The authors point to the success of other “fact-based public education campaigns” that have made a difference in other areas of health, altering behavior related to smoking and tobacco use and cancer.
“We recommend expanding and redesigning education programs to transform the understanding of pain, improving education for clinicians, and increasing the number of health professionals with advanced expertise in pain care,” they write.