January 19, 2012
To Fight Epidemic Of Unnecessary Suffering, Stanford Dean Calls For Major Public Health Campaign
The amount of needless suffering caused by both acute and chronic pain in the United States is a major, overlooked medical problem that requires improved education at multiple levels, stretching from the implementation of new public health campaigns to better training of primary care physicians in pain management.
"The magnitude of pain in the United States is astounding," write the authors of a perspective piece to be published Jan. 19 in the New England Journal of Medicine. The article is co-authored by Philip Pizzo, MD, dean of the Stanford University School of Medicine. Pizzo chaired a committee that issued an Institute of Medicine report in June which found that more than 116 million Americans have pain that persists for weeks to years with associated financial costs to the country ranging from $560 billion to $635 billion per year. The other co-author of the perspective, Noreen Clark, PhD, professor of health behavior and health education at the University of Michigan, was vice chair of the committee.
"During the work of the committee it became clear that one of the major challenges in addressing pain – as a public health problem or as something that impacts the lives of individual adults and children – is the need for improved education," said Pizzo, who is also the Carl and Elizabeth Naumann Professor of Pediatrics and a professor of microbiology and immunology.
There is misunderstanding and insensitivity about this issue from both physicians and the general public, and substantial education campaigns are needed to help battle this epidemic of unnecessary suffering, the authors write.
One of the major impediments to relief is patients' limited access to clinicians who are knowledgeable about acute and chronic pain. With fewer than 4,000 pain specialists currently practicing in the United States, it's necessary that primary care physicians step up and provide effective pain management care. Right now, due in a large part to inadequate education, that's not happening.
"Sadly, many physicians are viewed as 'poor listeners' by people living with chronic pain," the authors write. "Some physicians over-prescribe medications including opioids, while others refuse to prescribe them at all for fear of violating local or state regulations. ... Many people with chronic pain simply don't know where to go for help."
Research shows a lack of sufficient training for most physicians in the treatment of pain, beginning in medical school and stretching into areas of professional education, surprisingly even in such areas as oncology. The authors point to one survey of 117 medical schools that reported some schools provided only a few educational sessions on pain. Other studies showed that most primary care physicians feel "inadequately prepared" to counsel patients on pain.
"These deficiencies do not appear to be alleviated during residency or practice," the authors write.
Pain sufferers who go in search of help often face both the insensitivity and lack of knowledge of practitioners, and a public attitude toward chronic pain sufferers that sends the message that they need to "just suck it up."
"Often, an initially supportive community becomes intolerant or inattentive as the pain persists, which leads many people with chronic pain to give up, resulting in depression," the authors write.
The implementation of broad public education campaigns, along with targeted efforts to educate patients themselves, could help empower patients and their families to find the help they need. The authors point to the success of other "fact-based public education campaigns" that have clearly made a difference in other areas of health, altering behavior relating to smoking and tobacco use, cancer and Alzheimer's disease.
"We recommend expanding and redesigning education programs to transform the understanding of pain, improving education for clinicians, and increasing the number of health professionals with advanced expertise in pain care," they write.
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