The amount of needless suffering caused by both acute and chronic pain in the United States is a major, overlooked medical problem that requires improved education at multiple levels, stretching from the implementation of new public health campaigns to better training of primary care physicians in pain management.
“The magnitude of pain in the United States is astounding,” write the authors of a perspective piece published in the New England Journal of Medicine. The article is co-authored by Philip Pizzo, MD, dean of the Stanford University School of Medicine. Pizzo chaired a committee that issued an Institute of Medicine report in June which found that more than 116 million Americans have pain that persists for weeks to years with associated financial costs to the country ranging from $560 billion to $635 billion per year. The other co-author of the perspective, Noreen Clark, PhD, professor of health behavior and health education at the University of Michigan, was vice chair of the committee.
“During the work of the committee it became clear that one of the major challenges in addressing pain – as a public health problem or as something that impacts the lives of individual adults and children – is the need for improved education,” said Pizzo, who is also the Carl and Elizabeth Naumann Professor of Pediatrics and a professor of microbiology and immunology.
There is misunderstanding and insensitivity about this issue from both physicians and the general public, and substantial education campaigns are needed to help battle this epidemic of unnecessary suffering, the authors write.
One of the major impediments to relief is patients’ limited access to clinicians who are knowledgeable about acute and chronic pain. With fewer than 4,000 pain specialists currently practicing in the United States, it’s necessary that primary care physicians step up and provide effective pain management care. Right now, due in a large part to inadequate education, that’s not happening.
“Sadly, many physicians are viewed as ‘poor listeners’ by people living with chronic pain,” the authors write. “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.”
Research shows a lack of sufficient training for most physicians in the treatment of pain, beginning in medical school and stretching into areas of professional education, surprisingly even in such areas as oncology. The authors point to one survey of 117 medical schools that reported some schools provided only a few educational sessions on pain. Other studies showed that most primary care physicians feel “inadequately prepared” to counsel patients on pain.
“These deficiencies do not appear to be alleviated during residency or practice,” the authors write.
Pain sufferers who go in search of help often face both the insensitivity and lack of knowledge of practitioners, and a public attitude toward chronic pain sufferers that sends the message that they need to “just suck it up.”
“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 write.
The implementation of broad public education campaigns, along with targeted efforts to educate patients themselves, could help empower patients and their families to find the help they need. The authors point to the success of other “fact-based public education campaigns” that have clearly made a difference in other areas of health, altering behavior relating to smoking and tobacco use, cancer and Alzheimer’s disease.
“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.
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The pain suffered by older adults is the shared focus of the two newest entries in The Gerontological Society of America’s (GSA) From Publication to Practice* series. Together they address both pain management and new labeling changes for one of the most popular pain medications, acetaminophen. Both issues aim to provide readers with information on how new advances in pain prevention, treatment, and management may improve care and quality of life for older adults. The From Publication to Practice series was launched last year to promote the translation of research into meaningful health outcomes.
“Taken together, these two new resources will enable the gerontological community to identify opportunities to improve pain management services,” said Cathy Alessi, MD, the 2011 chair of GSA’s Health Sciences Section. “Research indicates that severe pain in older adults leads to a decreased quality of life, including both satisfaction with life and health-related quality of life.”
One of the installments, “An Interdisciplinary Look at Advancing Pain Care, Education, and Research: Responding to the IOM’s Call to Action To Improve Pain Management,” was supported by an educational grant from Purdue Pharma, L.P. While addressing shortfalls in assessment and treatment for older adults with pain, this publication aims to inform health care providers, researchers, policy makers, educators, caregivers, and patients about a recent Institute of Medicine (IOM) report, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.”
While pain affects approximately one-third of Americans – and exacts a huge toll from society in terms of morbidity, mortality, disability, demands on the health care system, and economic burden – it remains widely undertreated. GSA’s new publication also provides an overview of needs for care, education, and research, and lays out a blueprint for transforming pain care.
The other new issue, “An Interdisciplinary Look at Labeling Changes for Acetaminophen and the Implications for Patient Care,” was supported by McNeil Consumer Healthcare. It was produced in response to the U.S. Food and Drug Administration’s recent modifications to the recommended daily dosage of acetaminophen. The purpose of these changes is to make patients aware of the presence and amount of acetaminophen in single-ingredient and combination products – with the goal of preventing overdoses that can cause acute liver failure.
Acetaminophen is present in more than 600 over-the-counter and prescription products used by more than 50 million Americans each week. This commonly used medication is taken to treat conditions such as pain, fever, and the aches and pains associated with cold and flu. Acetaminophen – over-the-counter or prescription – is the most frequently prescribed agent for pain relief. This installment of From Publication to Practice provides essential information on the new labeling changes and describes the resulting implications for patient care, especially for older patients. It also presents important steps that clinicians and aging network professionals can take when educating patients.
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Virgil Mayer