Chronic pain is defined as any pain that lingers for more than 12 weeks, and you may be surprised to learn that it affects more than 100 million Americans every year. As part of our effort to help spread awareness about chronic pain and how these complicated conditions are treated, we wanted to share this handy infographic we found on the web.
If you enjoy the infographic, check out some of these related articles that focus on the diagnosis and treatment of chronic pain in America!
Speaking ahead of the annual meeting of the Association of Health Care Journalists, U.S. Surgeon General Vivek Murthy, MD, MBA, said that he is committed to reducing the number of prescription drug and substance abuse overdoses in the US.
As part of his effort to reduce overdoses, Murthy is reaching out to physicians and medical professionals who prescripe opioids for pain. He plans to write more than a million physicians, nurses, physicians assistants and dentists with a “personal entreaty” to change prescribing practices.
“Nurse practitioners, physicians, and dentists … they want to relieve suffering, they want to treat pain,” said Murthy. “What we have found is that many precribers were never really trained in how to treat pain safely and effectively. “That’s something we want to change.”
In his speech to the AHCJ, Murthy noted that left unchecked, opioids and prescription painkillers can lead people to search for newer, more powerful drugs, like heroin. According to Murthy, 80 percent of heroin users say their addiction began with prescription drugs.
“I see prescribers as being essential part of solution to opioid crisis,” he continued. “Unlike many other substances like heroin and other illicits, the majority of supplies of misused prescription opiates are coming from legally written prescriptions. That means doctors, dentists, nurse practitioners, and physician assistants have the power to turn the tide on the opioid epidemic by virtue of their ability to prescribe, and their ability to inform and educate patients. Our goal is to build a national movement in medicine to take on this crisis as one we’re uniquely positioned to solve as prescribers.”
To get a better idea of the scope of the problem, Murthy’s office plans to produce the office’s first-ever report on substance abuse, addiction and health.
“The goal of that is to bring together the best possible science on treatment and recovery, so we can equip practitioners, patients, and policymakers with the information they need to promote better health and treat addiction,” he said.
Murthy stated that opioid and substance abuse overdoses were one aspect of healthcare that he wanted to focus on, but the other topic centered around physician burnout. Physicians and individuals in the medical profession have some of the highest burnout rates of any job, and they routinely score low on tests of emotional well-being. Murthy and colleagues say the emotional drain is pushing skilled workers into other industries at a time when we need to be hiring more doctors.
My colleague Dr. Lance Silverman dives into the topic of physician burnout on his blog.
Chronic pain and prescription opioids are two topics that have been making national headlines over the last few weeks. The CDC announced a new set of recommendations for prescribing opioids and the FDA has required new warnings on opioid medications to ensure labels include more descriptions of the risks, especially for abuse, addiction, and overdosing.
With all the news about the issues with opioids, there has been more interest in alternative strategies toward chronic pain management. In the past, comprehensive chronic pain management programs were a preferred strategy. Over the past ten years, most programs have disappeared due to a lack of insurance coverage. The cornerstone of all these programs is combining conservative use of medications, interventions, and the strong input of physical therapy and behavioral health treatments.
Physical therapy (P.T.) is one of the essential needs of everyone with pain in order to develop a daily exercise program. Further therapy can maximize overall capability and improve the ability to function. The goals of therapy are three-fold. To work on overall strengthening and core muscles, aerobic conditioning, and stretching. Muscle strength allows one to be able to hold up the body and perform activities. Core muscles give the spine the ability to be upright, and most of us do not have good strength in these groups, and with a strong core, spine pain is much better controlled. Pain is often caused by tight muscles, so stretching keeps the muscles at the right length and decreases spasms. All three activities are necessary. It is like a three legged stool; Without doing one of the three, the stool tips over. You need all three bases to be stable.
The next method is a behavioral health intervention, and the goal is to train the brain to help control the interpretation of sensory signals. The brain has incredible power to manage all the signals it receives. Pain sensations are specific sensory signals, and the interpretation of the signals can be consciously modified. Normally the brain would just read these sensory signals as painful. If the brain is receiving many painful sensory signals, a short circuit can occur and the pain can become centrally amplified and intensified. Using techniques taught by psychologists, one can learn to modify the perception of the pain signals and essentially ignore them. Multiple different techniques have been used successfully including progressive relaxation, self-hypnosis, mindfulness, cognitive behavioral therapy and distraction. Again, to be successful with any of these therapies, one has to be interested and willing to put in the time and effort to make the techniques work.
Acute and chronic pain can be very successfully treated and managed with a variety of techniques. Opioid medications in reality are only a very small tool to control these symptoms. Controlling the opioid misuse requires patients to move beyond the want for a simple solution that takes no work. Chronic pain is not well treated with opioids for the long-term. It takes time and effort to control chronic pain, if one does not put in the work, there likely will not be a good solution.
New research out of Canada suggests that doctors should ensure that teens who are battling chronic pain and illness should have a support system in place to address their mental health, as it can help manage physical symptoms.
The study was small, but the findings speak to a larger issue that oftentimes gets overlooked when it comes to helping adolescents with chronic pain. For their study, researchers conducted an eight-week study with 28 kids between the ages of 12 and 17 who had been diagnosed with various chronic pain conditions. The group was split in two, with one group participating in the iPeer2Peer program.
Those in the treatment program were partnered up with an adult between the age of 18 and 25 who had also been diagnosed with a chronic condition. The mentors needed to undergo a 20-hour training session prior to being paired up with a mentee. The pairs talked via Skype twice a week for at least 20 minutes a session for the first two weeks, then at least once a week for the remaining six weeks. Researchers noted than sessions routinely ran about twice as long as the minimum 20-minute scheduled session. Mentors shared advice, offered emotional support and addressed any concerns or questions the mentee had.
Mentoring Chronic Pain
At the conclusion of the eight weeks, researchers uncovered:
Researchers believe that showing teenagers that they don’t have to fight their battles alone can be a significant step in helping them cope with their chronic condition.
“Young people with chronic pain can become socially isolated and many have never met another person with chronic pain,” said lead study author Sara Ahola Kohut, a pediatric health psychologist at The Hospital for Sick Children in Toronto. “By having trained mentors, young people who are only a couple years older than the teens, teach coping strategies, we believed the pain coping skills might be easier to learn and practice.”
Kohut concluded that anywhere from 11 to 38 percent of children and adolescents deal with chronic conditions at that stage of their life, so we need to start addressing the issue. This program may be the answer.
“The program is easily accessible, teenagers liked it, and it helped improve the teenagers’ ability to cope with pain.”
President Barack Obama shot down a proposal on Monday from the nation’s governors designed to curb America’s opioid and heroin crisis. The proposal called for limiting the number of high-powered painkillers a doctor could prescribe at a time, but Obama said the move could block access to drugs that people truly need.
“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said. “In some cases, addiction is already there.”
The recommendation had received bipartisan support at the National Governors Association’s winter meeting, but President Obama rejected the sweeping proposal. The president thanked the governors for crossing party allegiances to come to a solution, but he didn’t think it adequately addressed the full scope of the problem.
“This is an area where I can get agreement from Bernie Sanders and Mitch McConnell. That doesn’t happen that often,” Obama said.
According to the Centers for Disease Control and Prevention, heroin and prescription painkillers play a roll in the deaths of 78 Americans every day. Certain prescription opioids are seen as gateway drugs to heroin, which is cheaper and often much easier to obtain.
Vermont Govermor Peter Shumlin criticized Obama for rejecting the proposal, saying, “You can’t convince me that we’ve got 250 million Americans in chronic pain.”
The fact of the matter is that opioids are likely over-prescribed in this country, and while some doctors certainly hand them out too easily, for some patients, it is truly the only option that keeps their pain at bay. For others, surgery or costly therapy sessions are out of the question, so they rely on those painkillers to manage their pain. Dr. Steven Stack, president of the American Medical Association, praised Obama for shutting down the blanket rule which would have undoubtedly hurt a large portion of actual chronic pain sufferers.
“The complexity of the problem makes it difficult to create a successful one-size-fits-all approach,” Stack said.
Stack is right. There is no perfect one-size-fits-all approach to chronic pain care, just like there is no magic pill to solve one’s pain. In the end, we need comprehensive exams to understand to underlying cause of pain, and we need to work with patients to understand their treatment options and the potential implications of each. It’s much harder than simply prescribing a painkiller, and it also takes work on the patient’s end to work to get better and not just rely on their pain pills, but this duel-responsibility approach is what it’s going to take to start reversing the opioid crisis.