The Numbers Game: How Many Americans Have Chronic Pain?

The Numbers Game: How Many Americans Have Chronic Pain?

One of the nation’s largest drug screening labs says 50 million Americans suffer from chronic pain.

The American Academy of Family Physicians puts the number at 70 million, a figure long used by several other medical societies.

Last summer, the Institute of Medicine (IOM) raised the estimate even higher. It released the landmark study Relieving Pain in America, which declared that 116 million Americans suffer from chronic pain. That number has been repeated in thousands of news reports and dozens of medical organizations (including the National Institutes of Health and the FDA) have adopted the mantra: 116 million Americans are living in pain.

Or are they?

“It’s a ridiculous number,” said Dr. Andrew Kolodny, chairman of the department of psychiatry at Maimonides Medical Center in New York City. “That’s just an outrageous statement. It’s absurd to say almost half of all Americans are disabled by chronic pain.”

Dr. Kolodny is a controversial figure in the field of pain medicine. As president of Physicians for Responsible Opioid Prescribing, he’s been a vocal critic of the overprescribing of narcotic painkillers. Kolodny believes the pharmaceutical industry is behind efforts to exaggerate the number of Americans with chronic pain.

“My biggest concern is the way in which the number is used and the report itself is used by people advocating for aggressive prescribing of opioids for chronic pain. That really concerns me,” Kolodny told American News Report. “This was language that was lobbied for by the pharmaceutical industry and by organizations funded by industry. They wanted a report on chronic pain because they knew it could be used in advocacy for opioids or other treatments and ultimately they got the report that they wanted.”

Kolodny’s concerns are drawing new attention because of a U.S. Senate investigation of the financial ties between drug makers and non-profit pain organizations that often advocate the use of opioid painkillers.

In February, Kolodny raised his objections during the annual meeting of the American Academy of Pain Medicine. One of the authors of the Institute of Medicine report, Dr. Sean Mackey of  Stanford University’s School of Medicine, defended the IOM panel that wrote it, saying it received “zero, nothing, zilch, pubkiss” from the pharmaceutical industry.

Weeks later, the Institute of Medicine quietly revised it number. Instead of 116 million Americans living in pain, the IOM now estimates the number at 100 million.

Is Chronic Pain a Disease?

Kolodny thinks the new figure is still too high and has “dangerous implications.” He believes it will be used in lobbying efforts to get chronic pain classified as a disease.

“There are significant consequences if you call something a disease. Labeling anything a disease is something the industry is always very interested in, whether they want to call shyness a disease and call it “socialphobia” so that they can prescribe Zoloft for it,” Kolodny said. “If you say chronic pain is a disease, that means I can prescribe you OxyContin and I’m treating your disease.”

Kolodny thinks that’s the wrong approach. He believes doctors should treat the underlying conditions that cause pain – be they inflammation or fibromyalgia – before dealing with the pain itself.

“I do think chronic pain is a serious problem and highlighting that is important if it leads to people receiving evidence based treatment. Unfortunately, I don’t think that’s what is happening,” he says.

“It’s a disease and there’s plenty of data to support that,” says Daniel Bennett, MD, DABPM, a Denver pain physician who is the Chief Medical Officer of American News Report. Bennett believes the IOM’s old number of 116 million underestimates the number of Americans with chronic pain, because it doesn’t include millions of people who might never see a doctor for chronic back pain or headache.

“That’s why these studies are underestimating because they’re looking at actual physician encounters and that’s not the way we should be tracking pain,” said Bennett. “All they’re looking at is who is actually presented for treatment.  That’s underestimating the problem, especially since back pain is a male predominant problem. How many guys do you know that of their own volition go to the doctor? They don’t.  It’s their spouse or girlfriend, someone else is taking them, saying ‘I’m tired of putting up with this.’ Those are the ones buying over the counter non-steroids.”

A recent Gallup survey supports Bennett’s views. It found that 47 percent of people had at least one type of chronic pain. Over a third of those in their mid-50s and older have neck or back pain.

All of which raises the same question. How many Americans suffer from chronic pain?

“I wouldn’t even want to guess. I do think that true chronic pain is a serious problem and I think it’s a common problem, but I have no idea. I just think the 100 million figure is absurd,” says Dr. Kolodny. “Part of being alive means experiencing pain. So certainly there are 100 million people who will frequently experience pain. That doesn’t mean there are 100 million people disabled with the disease of chronic pain.”

Authored by: Pat Anson, Editor

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I don’t think I’ve ever read a more slanted, inaccurate assessment of the critical epidemic of chronic pain in this country. Nowhere is it claimed that 100 million people are permanently, totally disabled (as the term is legally and commonly understood – to wit, the inability to work) in this country. What’s absurd is that the rampant fear-mongering sensationalism the US media is only too happy to engage in is actually affecting policy and practice in this country. As Dr. Bennett points out, if anything, the number is too *low* because so many of us are either too poor to afford medical care, or we’re afraid to go — afraid because we don’t know why we hurt and the possibilities are frightening, and (much more commonly) afraid of being labelled drug-seeking addicts. The problem with the war on drugs is this: it’s become a war on chronic pain patients. Those of us who use prescription medication for our chronic pain and use it responsibly are lumped in with the *tiny* percentage of addicts who seek those prescriptions. (The government’s own statistics show that only 3% of prescription pain medication users abuse those drugs; when you factor out those with a history of addiction and abuse, the figure drops down to less than 1%.) As Shannon pointed out, abusers and addicts will ALWAYS find a way to get their fix, usually in illegal ways. The only people that the current hysteria over opioid prescriptions hurts are those who take such medication responsibly. The national freak-out over overdose deaths generally rests on the notion that such deaths tripled from 1990 to 2008. But in 2008, less than 15,000 people died from overdose (a figure that doesn’t seem to distinguish between accidental and intentional or suicidal overdoses). While each of those deaths is, to be sure, a tragedy, the number itself must be kept in perspective. (Car accident deaths for the same year, 2008, reached a new low of 37,000 – more than twice that of overdoses, for one example.) What non-chronically-pained people do not and apparently cannot understand is the emotional and psychological toll exacted on those of us who suffer from debilitating pain every single day of our lives. We are isolated from the rest of the world because, to put it bluntly, nobody wants to hear about our pain. We generally understand this – it’s not pleasant to hear someone complain endlessly about how much they hurt. But try to see it from our perspectives: it’s not easy for us to know how to respond in the first place, even to a question as simple as “How are you today?” Do we lie and say “Great!”? We’ll be treated with suspicion later, then, when our pain prevents us from doing something that’s asked of us. And if we’re honest and say “I hurt a lot,” we’re at best quickly avoided and at worst treated to a suspicious-sounding “Well, you don’t LOOK sick” followed by a long laundry list of recommendations,… Read more »

The numbers are ridiculous? Where is Dr. Kolodny’s proof of that? Did he read the whole IOM report? It didn’t say that 116 million Americans are permanently in chronic pain for the rest of their lives. But the problem is a BIG one if you have to live with it everyday and just try to function. Let me quote a piece from one article on the IOM report:

“…Yet the reports’ authors said they believed that they had actually underestimated the incidence of chronic pain — that which lasts 30 to 60 days or more and takes a toll on personal and professional life — because their data didn’t include people living in settings like nursing homes. Further, as baby boomers age, the rate of chronic pain increases daily.

“Pain is an experience that affects virtually every one of our citizens,” says Dr. Philip Pizzo, dean of the Stanford School of Medicine, who chaired the committee that wrote the report.

http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/#ixzz1v4v8jCtx

And I hope, Dr. Kolodny, that you never end up with a painful disease or injury that shatters your life. Cancer is not the only disease that causes pain. Perhaps you ought to read something I wrote on my blog – opioids are not a “bad” drug anymore than a drug like Ritalin or Vicodin or any other medication that can be abused. Give doctors better pain education. That alone should be a major help.

But if you cut off people like me who have a chance at life thanks to their pain medication – which I have taken for 12 years with no problems because I follow the dosage and don’t use it improperly – then you sentence a lot of people to suffer just because their are others who cannot control or do not want to control their behavior. You can’t legislate behavior. You can’t stop people from doing stupid and dangerous things if they want to badly enough.

If you haven’t read these article, please read them:

http://seattletimes.nwsource.com/html/localnews/2016994769_silent12.html?syndication=rss

http://news.yahoo.com/heists-overdoses-rise-canada-bans-painkiller-222007609.html

http://www.vancouversun.com/health/Summit+hears+calls+pain+strategy/6514998/story.html