Pain patients are being cheated out of safe, effective, affordable health care and it ought to be a crime. The situation has caused needless suffering, addiction and death. One hundred million Americans suffer from chronic pain. They should have access to all the therapies that could help them.
For decades now, access to pain treatment has been dictated by health insurance companies and by legislators overly beholden to pharmaceutical companies, all of whom are more concerned with their bottom line than with patients’ welfare. Current policies have not only endangered individual patients, they have threatened the existence of many essential health services.
Here are just a few examples:
- Physical therapy has a long history of reducing pain, increasing mobility, improving function and reducing disability. Physical therapy dates back to Hippocrates, the father of modern medicine, who used manual and water therapies to treat people in 460 BCE. Physical therapy has long been a staple of conventional medicine. Recent research has shown that for many pain disorders, including knee and back pain, physical therapy is at least as effective as surgical intervention with less risk and lower cost. However, since the advent of managed care, beginning in the late 1970’s, significant restrictions in the number of sessions covered has led to many patients receiving insufficient amounts of therapy. In addition, fees paid to physical therapists have not been increased in over 35 years, leading to a more than 65% reduction in inflation-adjusted income. To compensate, most physical therapists have had to reduce the amount of hands-on time they spend with patients, eroding the quality of care. Many physical therapists, unable to make ends meet, have left the field, leading to a shortage of care in many areas that is expected to grow significantly in coming years.
- Chiropractic treatment is recognized worldwide as an effective treatment for back and neck pain. Despite attempts by the American Medical Association to convince doctors and patients otherwise (the AMA lost a libel suit by a group of chiropractors in the 1980s), chiropractic care is very safe. The estimated risk for serious complications for cervical (neck) manipulation is 6.39 per 10 million manipulations; for lumbar (low-back) manipulation, the estimate is 1 serious complication for every 100 million manipulations, according to a 1998 study sponsored by nonpartisan nonprofit research institute the RAND Corporation. Compare this to the 156,000 serious complications per 10 million cervical spine surgeries and 32,000 serious complications per 10 million patients using nonsteroidal anti-inflammatory drugs (NSAIDs). Cost of chiropractic treatment is a small fraction of the cost of surgical care. Despite this, chiropractic has met the same fate as physical therapy—significant reductions in covered services, fees frozen for over 35 years, eroding the quality and availability of care.
- Psychotherapy, including cognitive behavioral therapy, has also been extensively studied and found to be an effective intervention to treat pain. Restrictions in access to care and fees frozen for over 35 years have also significantly reduced the quality and availability of this type of care. Over 93 million Americans now live in federally defined “mental health shortage areas” where there is less than one mental health provider of any kind (psychologist, social worker, psychiatrist, licensed mental health counselor) for every 10,000 people.
- Biofeedback, which uses sensitive electronic instruments to measure physiology and feeds that information back to patients so that they can learn to control their muscle tension, blood flow to extremities, heart rate and even brain activity. Biofeedback has been around since the 1960s and has hundreds of studies documenting its effectiveness for chronic pain. The evidence is strongest for headaches, including tension headaches and migraines. Insurance companies refuse to pay for biofeedback, saying it is experimental.
- Low level laser therapy uses near-infrared light to facilitate healing. Over 400 randomized, controlled human studies show that it is effective in reducing pain and inflammation and promoting healing for a wide range of painful conditions, including neuropathy, osteoarthritis, back and neck pain, non-healing wounds and CRPS. It is completely safe. Insurance companies say it is experimental and refuse to cover it.
- Marijuana is a plant that grows wild worldwide in all but the coldest climates. It has been used medicinally for thousands of years. It is the only known plant that contains compounds called cannabinoids, which also occur naturally in the human body and are used by the body for relief of pain. There is no such thing as a lethal overdose of marijuana and it is not physically addictive. In most parts of the U.S. it is a crime to grow or possess marijuana. Even in those states that have legalized marijuana for medical use, access is limited to a certain set of medical conditions and it must be prescribed by a specially trained physician. Medical marijuana is illegal under federal law and insurance never covers its cost, even in states where it is legally prescribed.
Acupuncture, massage, nutritional and herbal interventions, therapeutic exercise programs and other treatments that have been proven effective in pain reduction have similarly been ignored as tools in the treatment of pain. The most effective treatment of all is interdisciplinary treatment, where a diverse team of providers all assess and come up with a multi-faceted treatment plan to address each individual patient’s medical condition. Interdisciplinary pain clinics were proliferating in the 1990s, with over 1000 in the U.S. Then Perdue Pharmaceuticals began promoting its opioids as a cheap, non-addictive (they lied) treatment for pain. Insurance companies stopped paying for interdisciplinary clinics and over 90% of them closed. Availability of this type of care is growing everywhere in the world except in the U.S.
Currently, most insurance companies will pay for as many drugs in as high a dose as a physician is willing to prescribe and rarely say no to surgical interventions, despite the fact that these are the most risky and costly treatments. If patients want the safe and effective treatments mentioned above, they are on their own. And since many pain patients are in economic distress due to their conditions, that means no access at all.
Please help change this by signing my petition on www.change.org asking the President and Congress to pass a Pain Treatment Parity Act that would require insurers to adequately cover all pain treatments that are proven effective.
TO LEARN MORE READ – THE ULTIMATE GUIDE TO BECOMING PAIN FREE
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