Adequate pain care sorely lacking for patients

By Robert S. Boyd | McClatchy Newspapers
WASHINGTON — Medical science has learned a great deal about the causes of pain and ways to relieve it, pain experts say, but for a host of reasons, the treatment of pain and suffering has improved hardly at all in recent years.

John Seffrin, the president of the American Cancer Society, calls this "a national health-care crisis of under-treated pain.''

"Nearly all cancer pain can be relieved, but fewer than half of our patients report adequate pain relief,'' Rebecca Kirch, the society's associate director of policy, told a pain seminar in Washington last week.

Hospitals do a little better than that in managing pain for patients with all kinds of illnesses, according to a survey to be published Thursday in the New England Journal of Medicine.

The survey of hospitals in 40 metropolitan areas by the Harvard School of Public Health found that one-third of patients felt that their pain wasn't well controlled. The percentage of those who were satisfied by their pain care ranged from 72 percent in Birmingham, Ala., to 57 percent in New York City hospitals.

At least 76 million Americans suffer chronic pain, including as much as three-quarters of people who are older than 65, according to Dr. Ann Berger, the chief of pain and palliative care at the National Institutes of Health in Bethesda, Md.

"Pain is the most common complaint for which individuals seek medical attention,'' said Dr. Howard Heit, a chronic-pain specialist at Georgetown University in Washington.

"Considering the available research and medical technology we have today, it's a travesty that in 2008 so many pain sufferers are untreated or under-treated because of lack of awareness, education and misconceptions about pain and pain treatment,'' said Kathryn Walker, the president of the Maryland Pain Initiative, a volunteer organization of state pain experts in Baltimore.

One problem is that medical schools give only a "paltry'' one hour of training in how to understand and treat pain," said Will Rowe, the executive director of the American Pain Foundation, a national advocacy group that's also based in Baltimore.

As a result, Rowe said, "few physicians are equipped to adequately assess and treat pain.''

Nevertheless, "pain has a huge impact on society and the quality of life," said Dr. Larry Driver, the medical director of the Pain Management Center at the University of Texas in Austin. "It costs an estimated $100 billion a year in medical care and lost work.''

Despite the prevalence of pain, Driver estimated that the nation has only one pain specialist for every 21,000 suffering patients. ''There's not enough pain care to go around," he said.

In addition, only 2 percent of NIH research money goes for pain studies, Rowe said, despite the fact that pain is the "all-time number one cause for people to seek medical attention."

Pain experts distinguish between acute pain, as when you break an arm or hit your thumb with a hammer, and chronic pain, long-lasting suffering from injury or disease.

Acute pain can be beneficial, prodding the victim to avoid painful situations in the future, Georgetown's Heit said. Chronic pain, however, is "pain that has outlived its usefulness."

"If we don't treat acute pain, it moves to chronic pain (by) rewiring the nervous system," Berger warned.

The Pain Foundation says that the most common complaints are: back pain, at 55 million cases; arthritis pain, 43 million; and chronic headaches, 40 million.

The failure to treat pain adequately is the combined fault of doctors, patients, the legal system and the health-care system as a whole, speakers at the seminar said.

In addition to receiving inadequate training in pain management, doctors are often reluctant to treat patients for pain, Rowe said.

"They are hurried. They don't take time to listen. They're their least favorite patients to treat,'' he said.

Kirch, of the American Cancer Society, said doctors were concerned about possible "disciplinary action or criminal prosecution'' for providing powerful painkillers. Patients and their relatives also suffer "fear and confusion about possible addiction to pain medicines,'' she said.

Effective painkillers such as morphine, codeine and other so-called "opioids'' — derivatives of opium poppies — often are regarded as narcotics under federal and state regulations.

"The collision between the war on drugs and the war on pain has created a perfect storm of controversy,'' said Dr. Scott Fishman, the chief of the division of pain medicine at the University of California, Davis.

However, Rowe said that "opioids are some of the most effective and safe medicines when appropriately used.''

"Addiction to opioids in the context of pain treatment has been reported to be rare in those with no history of addictive disorders,'' Heit said.

People are often reluctant to tell their doctors they're hurting because they're embarrassed and they think they should just put up with it, Driver said.

"Women don't seek pain relief as much as men,'' he said. "They fear being labeled as complainers.''

Insurance is also a major problem for pain sufferers, the NIH's Berger said. Medicare doesn't cover most palliative care, and millions of people have no health insurance.

Besides opioids, pain specialists offer a variety of treatments to relieve suffering. According to Driver, they include nerve surgery, rehabilitation, anesthesia, psychological therapy, lifestyle changes and alternative medicine, including acupuncture, yoga and massage.