Pain Management in the United States - What Is the Prognosis?

The US is in the midst of a pain management problem of epidemic proportions. To put it in "medical" terms, the "patient" is on life support in the intensive care unit, and the "doctors" need to huddle to figure out how to save the "patient". According to a recent Institute of Medicine study, over 110 million Americans suffer from chronic pain at an annual cost of over $500 billion dollars. Wow!

So what to do? One of the most interesting facts that came out of the the IOM report was that while the cost of pain management annually is in the hundreds of billions of dollars, the amount of money spent on pain research is only between $200 to $300 million dollars. There is a huge disconnect between the amounts of what it cost and what is being done to rectify some of the problem. More funding at the NIH level is necessary to help produce viable solutions for helping patients and get the pain management situation off of "life support".

Very few of the new medications coming into the marketplace are for pain. What exists now are mostly narcotics, which can work very well but have lots of side effects and addiction potential. New drug classes are needed desperately to help with pain that have different side effect profiles, less tolerance, and less problems with addiction.

More education for medical providers is necessary. During training, medical students receive very little training in pain, which is amazing considering the extent of the problem. It would be impossible to have all patients in pain taken care of by pain management specialists, so all doctors, especially primary care doctors, deserve pain management training.

Along with the training changes, another aspect of pain treatment recommended in the report is to shift pain centers to comprehensive integrated models rather than simply "pill mills". This would entail services such as physical therapy, chiropractic, acupuncture, psychology, interventional pain management, and spinal decompression therapy along with medications.

There is considerable space in the report discussing reimbursement changes as well. When you look at reimbursement for the time spent on patients in pain and all the education and options, the visits can easily take 45-60 minutes. Right now, reimbursement is lacking for these extensive visits.

The report was received very well with 35 professional organizations lauding the findings. If the recommendations can be even partially implemented, maybe over the next few years the "patient" can be upgraded from critical to stable.