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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