Chronic pain is widespread, misunderstood

Millions of Americans are suffering needlessly with chronic pain, according to a new book, A Nation in Pain.

The author, Judy Foreman, calls the opioid wars not only medical but psychological, economic, political and cultural. We are suffering needlessly in what she calls “an unrecognized health epidemic.”

Pain is the main reason seniors visit their doctors. Research has shown that 50 percent of older adults who live on their own and 75 percent to 85 percent of the elderly in care facilities suffer from chronic pain. Yet, pain among older adults is largely undertreated, with serious health consequences such as depression, anxiety, decreased mobility, social isolation, poor sleep, and related issues.

Doctors-to-be, however, get only 8 to 16 hours of pain instruction over four years. Only four U.S. medical schools, Foreman writes, get a full course on pain management. Veterinarians, she says, get twice as much pain instruction as do physicians. The country has only 3,000 to 4,000 pain specialist physicians.

She writes that in one survey of doctors about a third of them said they weren’t comfortable about treating patients with chronic pain. And young doctors have little interest in learning more.

Patients who seek relief from agony are often suspected of seeking mind-altering recreational drugs. Sometimes they are dismissed as drug addicts.

Foreman writes that two public health issues are on a collision course – abuse of narcotics for pain, such as Vicodin – and street drugs such as heroin. While the government has cracked down on illicit narcotics, regulation has spread to regulation of medical narcotics.

She says, “Often older people with no history of drug abuse can’t get drugs they need. Millions of people with chronic pain can’t get the drugs they need.

“Physicians have recognized the under-treatment of pain as inhumane and have called for reforms in regulation. But there remains a pervasive suspicion about narcotics, which allows the epidemic of untreated suffering to continue.”

Few would deny potent painkillers to the terminally ill who are dying of diseases such as cancer. But the sobering news is that even powerful drugs aren’t up to the task of relieving pain. Opioids cut pain by only 30 percent to 40 percent, she says — even in high doses. Even in hospice, pain is quite common, she says.

Foreman’s book goes beyond its emotional appeal and reports arguments about the failures of palliative care in the U.S. Pain in itself lacks an institution or establishment for pain management.

She reviews evidence of some promising approaches, ranging from massage to nutrition to acupuncture. She argues that fixing pain is a moral imperative.

The National Center for Complementary and Alternative Medicine announced in September that 13 research projects totaling about $21.7 million over 5 years will explore non-drug approaches to managing pain and related health conditions such as post-traumatic stress disorder (PTSD), drug abuse, and sleep issues. The effort seeks to increase options for the management of pain and associated problems in U.S. military personnel, veterans and their families.

One positive development: medical marijuana may be able to provide chronic pain relief where many traditional chronic pain medications don’t. Cannabinoids have documented analgesics that make medical marijuana an effective medicine to treat some cases of chronic pain. In scientific studies, most medical marijuana patients experience pain relief. While marijuana potentially has detrimental mental effects, sometimes the pain relief may be worth it.