Woman with hip pain

Woman with hip pain

The Institute of Medicine (the medical branch of the US National Academies of Science) released a report brief on June 29, 2011 on the state of chronic pain in America, entitled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.  The purpose was to assess how pain affects people of different socioeconomic backgrounds, and what can be done on the national level to improve awareness and treatment.

Chronic pain affects at least 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity.   It is  a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

The toll documented in the report is staggering. Childbirth, for example, is a common source of chronic pain.  The institute found that 18 per cent of women who have Caesarean deliveries and ten per cent who have vaginal deliveries report still being in pain a year later.

Ten per cent to 50 per cent of surgical patients who have pain after surgery go on to develop chronic pain, depending on the procedure, and for as many as ten per cent of those patients, the chronic postoperative pain is severe.

The risk of suicide is high among chronic pain patients. Two studies found that about 5 per cent of those with musculoskeletal pain had tried to kill themselves; among patients with chronic abdominal pain, the number was 14 per cent.

For patients, acknowledgement of the problem from the prestigious Institute of Medicine is a seminal event. Chronic pain often goes untreated because most doctors haven’t been trained to understand it. And it is isolating: family members and friends may lose patience with the constant complaints of pain sufferers. Doctors tend to throw up their hands, referring patients for psychotherapy or dismissing them as drug seekers trying to get opioids. “Most people with chronic pain are still being treated as if pain is a symptom of an underlying problem,” said Melanie Thernstrom, a chronic pain sufferer from Vancouver, Washington, who wrote The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering (Farrar, Straus & Giroux, 2010) and was a patient representative on the committee. “If the doctor can’t figure out what the underlying problem is,” she went on, “then the pain is not treated, it’s dismissed and the patient falls down the rabbit hole.”Among the important findings in the Institute of Medicine report is that chronic pain often outlasts the original illness or injury, causing changes in the nervous system that worsen over time. Doctors often cannot find an underlying cause because there isn’t one. Chronic pain becomes its own disease.

“Having pain that is not treated is like having diabetes that’s not treated,” said Ms. Thernstrom, who suffers from spinal stenosis and a form of arthritis in the neck. “It gets worse over time.”

Ms. Thernstrom compared the effect of chronic pain on the body to the rushing waters of a river carving out a new tributary. Pain, she says, also changes the body’s landscape.

“My pain is at the level where it’s manageable,” she said. “I do wish I had gotten aggressive treatment in the first year. There is a window of time to intervene, because pain changes your nervous system and pain pathways develop.”

“When pain becomes chronic, when it becomes persistent even after the tissue and injury have healed, then people are suffering from chronic pain,:” Mackey said. “We’re finding that there are significant changes in the central nervous system and spinal cord that cause pain to become amplified and persistent even after the injury has gone away.” The pain report is only a first step for the community of medical professionals who treat pain. It will be up to medical schools to begin better education of doctors in the treatment of pain, and the National Institutes of Health to decide whether to promote research into chronic pain.


My comments:

This report is an important milestone in creating a national awareness of the “epidemic of pain” in this country.   Chronic pain is a very difficult problem to treat, because in most cases, there is nothing left for the doctor to do.  It truly frustrates doctors to see patients not getting any better over time.  Many primary care doctors dread having to see their chronic pain patients come in, because of the reasons stated in the article– suspicions of exaggerated symptoms, assumptions of pain reliever drug addiction, psychological problems, etc.

More attention is needed in formulating a strategy to prevent chronic pain from happening, and ways to better manage it.  This study is a good first step towards that direction.

If you have chronic pain, it still is a good idea to do the things that make the body healthier overall:  give it the building blocks to regenerate and repair tissue (high nutrient density foods); avoid ingesting toxins such as smoke, alcohol, preservatives, and pesticides; drink pure, clean water; get a good dose of Vitamin D every day by going outside in the sun; do short workouts that engage all body parts in unison every day, avoid negative people, negative media, and negative thoughts as best you can; engage in activities that require concentration; socialize with positive people; laugh to your heart’s desire, and get enough rest each and every day.  These activities may not cure chronic pain, but can make it more manageable.



The New York Times, Giving Chronic Pain a Platform of Its Own

The Institute of Medicine, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

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