August 13, 2013
Chronic Pain Is A Problem Few Doctors Can Address
Enid Burns for redOrbit.com - Your Universe Online
Most doctors are trained and well-equipped to treat acute pain, or pain that results from an injury and will subside with treatment, but few doctors are trained to address chronic pain. A new study from Henry Ford Hospital in Detroit finds that of the 117 US and Canadian medical schools, only four US medical schools put a required course for pain management on the schedule for medical students.
Chronic pain is a growing issue with more and more patients suffering from regular pain. The hospital estimates that 100 million people in the US live with chronic pain. It accounts for roughly a $635 billion annual split between health care costs and loss of productivity. The growing number of patients with chronic pain outnumbers medical specialists by a wide margin. The report says that a 2011 study found that for every medical specialist, there were 28,500 patients.
Many of those patients go to their general care physicians, and not specialists, to help with pain management.
"It's a major health care problem," said Raymond Hobbs, M.D., a Henry Ford Internal Medicine physician, and senior author of the clinical review published in the Journal of American Osteopathic Association. "We have physicians who have been well trained and have been practicing medicine a long time, but didn't receive training in pain management."
While acute pain results from an injury or is otherwise temporary and is resolved within three-to-six months, chronic pain persists for much longer. Chronic pain is often long-term and even lifelong. Chronic pain is also not always consistent with an injury, and for that reason can be a challenge to the doctor treating the patient.
"Pain is the most common reason a patient sees a physician. For most patients, the duration of the pain is short," said Dr. Hobbs. "Unfortunately, for some patients the pain never goes away. It is these situations that present physicians with their greatest challenge since few are formally trained in effectively managing pain."
The physician needs to look at the pain, but also how it affects the patient's life, said Hobbs. Pain affects a patient in terms of psychological, social and cultural contexts.
"Negative emotions can increase the perception of chronic pain, whereas a positive emotional state can lead to a better response," Dr. Hobbs said.
Dr. Hobbs recommends a number of strategies to help physicians work with chronic pain patients:
• Work in collaboration with a team of specialists comprising primary care, physical or occupational medicine, pain management and mental health.
• Patients being considered for oral opioid therapy like morphine, codeine and fentanyl should be screened for substance abuse using a five-point risk assessment tool.
• Set a threshold dose of 200 mg/d or less of oral morphine equivalents per day.
• Follow the so-called Universal Precaution model that calls for a complete medication evaluation and regular assessments of the four A's of pain medicine: analgesia, activity, adverse effects and aberrant behavior.
Prescriptions of short-acting opioids help establish daily requirements for patients before long-acting opioids are prescribed.
"If large doses of breakthrough medications are needed on a regular basis, then the physician should consider increasing the long-acting medications and evaluating whether the underlying problem is worsening," said Dr. Hobbs.
"Physicians have a moral responsibility to help their patients," said Dr. Hobbs. "We also should realize the opportunity we have and to use it to decrease our patients' suffering and to help restore their quality of life."