Addressing chronic pain, a hard-to-treat yet highly common condition, costs the United States as much as $635 billion a year and requires a much more comprehensive strategy for curbing lost productivity and healthcare expenses, according to a new government report.
At least 116 million U.S. adults -- or about four in 10 -- suffer from chronic pain every year, leading to extra sick days, lost wages and productivity, the Institute of Medicine (IOM) said Wednesday.
Chronic pain is defined as pain that lasts more than several months. It remains hard for doctors to diagnose, is often self-treated by patients and commonly perceived as less than a legitimate condition.
"Many health care professionals are not adequately prepared to provide the full range of pain care or to guide patients in self-managing chronic pain," IOM researchers wrote in the report mandated by Congress through the 2010 U.S. healthcare overhaul.
The IOM report excluded costs associated with pain in children or members of the U.S. military, making the estimate conservative and yet higher than economic costs of heart disease, cancer and diabetes, according to its researchers. The federal Medicare program takes the brunt of the medical costs of pain, bearing a quarter of expenditures, the report said.
Chronic pain commonly sets in after other illnesses, injuries and medical treatments. Similar to that, acute pain -- also addressed in the report -- is a sudden, short-lived kind of pain, but can be a recurrent and equally complex problem.
Pain in the lower back is the most commonly reported pain in the United States, followed by knee pain, severe headaches or migraines and neck pain.
Looking for ways to manage pain, many sufferers resort to painkillers, including prescription opioids such as morphine and oxycodone. More than 33 million people abused opioids in 2007, resulting in more overdose deaths than heroin and cocaine combined, according to the latest government data.
"It's a conundrum of opioids," said Noreen Clark, vice chair of the IOM committee that organized the study. "There are people who really need access to pharmaceuticals to manage their pain and there are some who abuse the pharmaceuticals, but the abusers are a very-very small proportion of those who need but don't have access to the treatment."
Drugmakers including Pfizer Inc have been developing painkillers that are tamper-resistant to prevent abuse, including pills that make it difficult to snort or inject the drugs.
IOM's report urges more professional education as well as more data collection and research into the phenomenon of chronic pain, in part to get rid of various social stigmas associated with pain as a disease.
The call comes a day after the American Society of Interventional Pain Physicians lobbied Congress to pass a bill that would require physicians to go through special training before prescribing painkillers.
Citing a recent study, IOM said only five of 133 U.S. medical schools have required courses on pain and 17 have elective courses.
The IOM report also calls on federal and state insurance programs, Medicare and Medicaid, together with private health plans and workers' compensation programs to address lags in pain care coverage.
