by Agent G

Created on: June 30, 2009

Over 25 million Americans experience acute pain each year. (Vo APA 2008 374) According to recent surveys, 1 in 6 Americans live with chronic or recurrent pain; Americans pay an estimated $120 billion a year in medical costs and lost productivity, and pain accounts for 50 million sick days per year in the United States. (Hubbard 2005) All forms of pain negatively affect quality of life, including personal and work relationships, and spiritual, social, and psychological well being. (American Pain Foundation 2008) Unfortunately, despite recent advances in the understanding of pain control, pain remains unrecognized or undertreated by the medical community (physicians, nurses, and pharmacists). (Bertakis 2004) resulting in one-fourth of chronic pain sufferers changing physicians at least 3 times due to inadequate management of their pain. As a patient with chronic pain, it is imperative that you fully understand the gaps in the medical community so you are better able to demand appropriate care for yourself.

Compounding the problem, fewer than 6,000 health care providers have any much-needed formal pain management training, such as a clinical practicum in healthcare training program, a certified professional education program, or hands-on clinical training and mentoring in a pain clinic. (Padgett 2006) A study of 111 PCPs at 8 community clinics (including physicians, residents, NPs, and PAs) found that 37.5% of adult appointments in a typical week involved patients with chronic pain complaints. Participants reported inadequate training in treating chronic pain. (Upshur 2006) This lack of education can lead to years of undue patient suffering. Patients need to become their own advocate. Educate yourself, and do not fall into the trap of either over or undermanagement of your pain.

Across the field of pain management, there is a general concern and reluctance regarding opioid use due to the potential for abuse, addiction, and diversion. However, it may be that a lack of education about managing patients with acute and chronic pain is driving pharmacists and physicians of all practice types to use weaker agents for pain management; the unfortunate result is suboptimal patient care. These fears are compounded by worries about DEA scrutiny in this era of increasing federal attention on potential abuse of all medications.

In addition to physician recognition of pain and ongoing management, there are unmet pharmacologic needs across the spectrum of pain management. Although numerous pharmacologic agents are available for the relief of moderate to moderately severe pain, the current armamentarium remains incomplete. Combination opioids are widely prescribed analgesics, but despite their extensive use, all combination opioids are currently available only as immediate-release formulations. (Vo APA 2008 373) In a nationwide survey of 491 physicians who treat pain, most reported difficulties managing pain patients with currently available pain medications. Seventy-nine percent of physicians agreed that patient compliance with pain medication was less than optimal. Ninety-six percent of physicians state that their chronic pain patients frequently wake during the night due to uncontrolled pain. This survey highlights some unmet needs experienced by pain patients taking IR pain medications. (Vo APA 2008 373) As a patient, it is important to do your own research in order to fully understand the types of pain management medications available to you. Your local pharmacist is a excellent resource and should be used to help inform your decision before and after visiting your doctor. Remember, only you know your own body.

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