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.”

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.”

Leave a Comment