ASA December 2002 Newsletter

In July 2002, U.S. News and World Report released its annual rankings of the “Best Hospitals in America.” In the report, readers learned where to receive the “best care” for various illnesses by specialty type. It is little surprise that there was no mention of where patients suffering from chronic pain can seek relief. As is well known to most pain management professionals, but known to few others, chronic pain remains one of the most undertreated, under-recognized and costly diseases in the world.

Chronic pain is a broad category representing diverse syndromes ranging from headaches to joint pain to fibromyalgia. A shocking proportion of the American public suffers from one or more of these syndromes. Epidemiological data show that roughly 6 percent of American adults suffer from chronic daily headache, in which a patient reports having headaches during at least five out of seven days of the week. Estimates place the total number of individuals suffering from some kind of recurring or persistent pain at nearly 50 million. Chronic pain harmfully impedes quality of life and ability to perform activities for daily living and extracts an extraordinary cost in worker productivity. The late John J. Bonica, M.D., anesthesiologist and distinguished pain scholar, estimated an annual loss of 400 million workdays and $79 billion due to pain-related health problems.

Fortunately focused biomedical research has resulted in new and effective therapies that are the mainstay of modern pain management. Anesthesiologists today have a substantial arsenal with which to address pain problems ranging from powerful pharmacologic therapies to sophisticated, well-placed nerve blocks. The complex nature of these therapies necessitated the development of an entire subspecialty of the profession devoted to pain management. Despite the emergence of this subspecialty, the general public remains largely unaware of its existence — as evidenced by U.S. News and World Report’s omission of pain management as a separate category of care — and is unable to reap the benefits that sophisticated pain treatment offers. Sufferers of chronic pain usually become aware that there are physicians whose entire practice is dedicated to alleviating pain only when introduced to it by their primary care providers.

Even so, many primary care physicians often fail to refer chronic pain patients to subspecialists. Pain specialists and patients report three key reasons for this referral failure: 1) a professional unawareness among primary care providers of the potential treatments pain medicine professionals have to offer, 2) a reluctance to refer a patients’ treatment out of one’s own control and 3) fear of the addictive qualities of some pain medication prescribed by pain specialists. The result is that many pain patients can spend years of their lives suffering without access to or knowledge of treatments that can vastly improve their everyday lives. Often unfounded fears of addiction to medication that can be prevented when dosed and administered by an experienced professional take precedence over the simple goal of making a patient feel more comfortable and functional. Sadly only a small number of motivated patients faced with intense suffering undertake the difficult, tortuous process of learning about treatment options by themselves.

Health care systems, and particularly anesthesiologists specializing in pain management, must do a better job of making pain care services more broadly available. Family physicians and internists must educate themselves and their patients about the promise of pain medicine. Pain specialists, for their part, must strengthen public awareness of their existence through an increased attention to publicizing their work — if not to improve their practice, at least to strengthen their profession. Given the substantial social burden of chronic pain, these specialists must become as visible as other specialized care providers. When this happens, pain medicine physicians will have reduced the single greatest barrier that prevents individuals from receiving any kind of appropriate care: knowledge.

Sachin H. Jain is an M.D./M.P.P. candidate at Harvard Medical School and the John F. Kennedy School of Government. He resides in Boston, Massachusetts.

Subash Jain, M.D., is President, World Foundation for Pain Relief and Research Advisory Board and Chair, Hackensack University Medical Center Department of Pain and Palliative Care, Hackensack, New Jersey.

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