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The Undertreatment of Pain

Posted · 22 Comments
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Over 100 million Americans suffer from chronic pain.  Chronic pain costs the United States about $300 billion annually in medical expenditures and approximately $300 billion on lost productivity.  These frequently cited statistics, alarming in their own right, do not even begin to quantify the suffering of those in chronic pain and the negative impact on their families and communities.

Despite the enormous amount of money spent treating chronic pain, a frequently heard mantra throughout the land is that “pain is undertreated”.  Obviously, if so many people are still suffering and the economic impact is so substantial, it must be true.  But what does this phrase really mean?

The idea that pain is undertreated was part of a marketing campaign by Purdue Pharma, starting in 1996.  Purdue wanted to convince doctors to widely prescribe their new extended release opioid, Oxycontin.  They persuaded doctors that the solution to inadequately treated pain was their drug and, by the way, it was perfectly safe because it was not addictive.  Purdue’s claim about Oxycontin’s safety was a lie and they later pled guilty to charges of consumer fraud.  However, their marketing strategy was very successful. The number of opioid prescriptions skyrocketed and most people came to believe that pain is undertreated and that the solution is more opioid prescriptions.

Considering the huge financial outlays for chronic pain treatment coupled with poor results, it is more accurate to say that most pain patients get treatment, but it is often ineffective and sometimes makes them worse.  Numerous studies have found that pain patients who take opioids end up with more pain, more disability and lower quality of life than similar patients who never took opioids.  The other common intervention for chronic pain—surgery—also in too many cases does not solve the problem and sometimes leave patients worse off.

The real truth is that pain patients are being denied the safest and most effective treatments—treatments that get at the underlying causes of their problems.  When managed care companies came on the scene in the late 1970’s they immediately began restricting access to health care providers who were not physicians, including chiropractors, physical therapists, occupational therapists and psychotherapists.  Annual visit limitations, preauthorization requirements and medical necessity reviews were implemented that sharply decreased the number of sessions patients received of these proven therapies for pain.  When pharmaceutical companies began marketing opioids for chronic pain in the 1990’s, insurance companies saw them as a cheap solution, and the restrictions on hands on chronic pain care increased.  Insurance companies have also used another weapon to reduce access to this type of care even further—they have not increased fees for these providers for almost 40 years.  This has reduced both the quality and availability of care.

In addition, new evidence of the effectiveness of other therapies in relieving pain, including acupuncture, nutrition, herbal medicine, biofeedback, low level laser therapy, medical marijuana and many others, is universally dismissed by insurance companies and coverage is unavailable.  Most pain patients cannot afford to pay out of pocket for these promising treatments.

Pain patients need and deserve relief from their suffering and that should mean that they can get affordable access to all of the treatments that can help them, not just drugs and surgery.

If you agree, please sign my petition on change.org for a Pain Treatment Parity Act that would require insurers to cover all proven treatments for pain.

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22 Responses to "The Undertreatment of Pain"
  1. pat says:

    I have RA, and have had numerous joint replacements, have tried holistic, diet changes, etc.
    Still suffer from chronic pain, fatique, etc. Opiates, if used correctly, are very helpful.

    • PJ says:

      I have RA also. Agree fully. Would consider THC if it was available.

      • M.Cole says:

        you can get the T.H.C or just the cannoid liquid here legally in the S.F. Area. I use to have my hospice patients say it helped them very much with their pain and other problems when nothing else would help.

    • D says:

      I agree. They are rhe only thing that keeps me functional (16y now)

    • Jennifer says:

      I agree with Pat. I have FM and a whole host of other physical issues. I have tried chiropractic, massage, acupuncture, TENS, psychotherapy and opioid therapy. Nothing gives me any lasting relief except the opioid therapy. If used as prescribed and for true physical pain it is effective and nonaddictive. It’s when people take it for the brief feeling of euphoria you can get when you take a higher dose that it becomes addictive. It’s those people who have abused the drug that now make it difficult for those of us who take it properly and truly need it, to get it.

  2. Jean kirschenheiter says:

    I’ve suffered with chronic back pain for years. I’ve also been on many different opioid medications. Certain ones did help me before I had back surgery. Now 6 months later I’m still having pain and it hurts to literally sit. Doctors don’t want to give me any medication anymore and I’ve never had a issues with opoid addiction. I’ve weaned off them very smoothly but meanwhile I have nothing to take to ease my daily pain.

    • Stacy Cooper says:

      I too had back surgery and the pain is worse. I had a wonderful doctor who was willing to try me on the Fentanyl pain patches and it was a true life saver. I no longer ride the roller coaster of taking too many oral opiods and running out and going through withdrawals until my prescription refill day. I still live with pain but at least it’s manageable. You may mention it to your doctor.

  3. Cindy Perlin says:

    There are many non-pharmaceutical treatments for chronic pain, including physical therapy, chiropractic, massage, psychotherapy, biofeedback, exercise, herbs and medical marijuana. Have you tried any of those?

    • Kay Massey says:

      Have you, Cindy Perlin? Just asking.

      • Peggy Butke says:

        I’ve had all pain block shots, cortisone enjections in joints and trigger points. Acupuncture helped but I’d not covered by Medicare. Massage therapy helped but they won’t pay for that either. I’ve had physical therapy. Nothing has helped for more than a couple of weeks. I have my severe Stenosis and was advised against chiropractic care.
        My lover back had stress fractures which they cemented and I can walk now.
        I live in Kansas and medical Maiijuana is not legal here. Probably won’t be anytime soon. I live with pain everyday. Some days are tolerable and some I can hardly bare it. I can’t vacuum or mop or clean the shower. I’ve had many surgeries. I was in several tear end collisions. I would give up my Vicuprophen for marijuana if it were legal. So far my dr of 4 years has given me my meds. If he dies or retired I’ll be screwed! It’s people like me that suffer. My husband works as many hours as he can. To help pay my bills. The Doctors need to swing the trend to less drugs to healthy people. However people like me that have had pain for 20 years and done all we can do, need pain meds in reasonable strength and number. I use pain meds in order to go to church and places other people take for granted. The drug company and the fr knew that Ocycontin was addicting! A dr should have recognized that .
        Don’t need to pass them out like candy but they have their place in treating chronic pain for people that have no options left.

      • Linda says:

        She is so insulting. I have tried acupuncture, chiropractic, yoga, herbs, Chinese medicine, physical therapy, supplements, exercise, not exercising, heat, cold, TENS unit, therapy, antidepressants, steroid injections, and yeah I still have pain.

  4. Joseph Tregoning says:

    The explosion about opioids being overused and people dying from them is misstated.

    Opiates help many people. The people who are addicted are generally drug addicts although there are some people who do not manage their medicine and become addicted.

    I have never had a problem with an opiate, going on or going off. It relieves my pain when nothing else will.

    I have tried every route to ease my pain. Unless someone can tell me with absolute certainty that my pain will disappear, This is the only thing I have to cut the pain, even a little bit. It does not make my pain worse. That is ridiculous.

    I tried alternative therapies. No go.
    I wish the writers of these articles would write about reality, rather than hearsay.

  5. kelly says:

    As a chronic pain patient, I think it’s so unfortunate that there are many proven ways to combat chronic pain that are offered in other countries but not the US. Yet getting to the root would be wonderful, but it’s about a quality of living your life as best you can. Every patient should be.able to choose with a doctor’s informative exam, the BEST treatment for them. What works for one might not for another.

  6. Barbara W OConnor says:

    I have rheumatoid arthritis and live with pain on a daily basis. I can not walk my dog unless i want to be down with intense pain for 3 days or more. I can only exercise in water which helps keep the pain less intense and some what tolerable. I dont want opoids for they only make me nauseous and sleeply. I prefer awake alert and aware. Some days are better than others but everyday there is pain my constant companion. Somedays my companion screams and is really loud. Somedays its quite just enough to let me know it remains present.

  7. Barb says:

    I became a Wellness Coach To help chronic pain sufferers navigate ALL the options avaulable. It can be overwhelming. I help clients conquer pain and achieve wellnes. #healfibropain.com

  8. Vicki says:

    After you have tried Ortho’s, Chiro’s, P.T., Neurologists, Acupuncture, Diet & Exercise, Pain Management… It gets a LITTLE frustrating and exhausting!

  9. I am a56 year old women with fibromyalgia, about 20 years now plus degenerative arthritis, I haven’t been on a lot of opiods. Have been on Lyrica, Nerontin, Mobic, Norflex, Naproxin, the one that worked the best was Nuerontin. With time though the Neurontin has stopped its effectiveness. I am thinking about going to a pain clinic.

  10. Robin says:

    I have Rheumatoid Arthritis, I’ve been using opiates to help relieve chronic pain for years and I have never had a problem with addiction. It has been hell for me in the recent years to try to convince a doctor to prescribe these much needed medications. They are scared out of their wit that they will either go to jail or lose their licence to practice medicine. This crack down on opiates is making life very difficult for people like me and there are a lot of us. I’m sick of the insanity.

  11. S. Webb says:

    Well, kratom was a great pain reliever. Too bad it’s being banned. I never experienced a high from it, but I did find it very helpful and legal and safe. But the DEA is banning it as Schedule I on September 30th. Even meth is a Schedule II. There have been reliable, ethical vendors who test their product quality and have done sufferers a service. They will also be put out of business.

  12. Sarah says:

    Kelly you are so very right. I’ve been dealing with chronic pain caused by multiple ongoing issues for 17 years and have done and tried so much. Now every provider is a sceptic and I am being told to just deal with it that nothing will make it better. Which we all know is not the ultimate answer. It is rediculous that there are other safe effective ways to manage pain that we are not given access too. Think of how many lives it could impact and save!

  13. Heather says:

    I’ve been in pain For nearly 35 years. I have not taken opioids…..because I was too afraid to. In tired of being in pain. This is getting to be absurd, I need relief.

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