This is hard to believe: Only five of the nation's 133 medical schools require students to take courses on pain and just 17 offer elective courses. This at a time when 116 million adult Americans experience pain on a chronic basis. And the cost to the national economy in terms of disability days, lost wages and productivity is a staggering $560 billion to $635 billion a year. That's more than the costs of cancer, heart disease and diabetes combined.
Those facts come from an Institute of Medicine report in June, "Relieving Pain in America, a Blueprint for Transforming Prevention, Care Education and Research." The report calls on public and private organizations across the country "to create a cultural transformation in how the nation understands and approaches pain management and prevention." Philip Pizzo, M.D., a professor of pediatrics, microbiology and immunology at Stanford, who chaired the IOM committee, said health care providers, educators, policymakers and others have "a moral imperative" to address the problem.
Pain is a knotty concept to get our minds around. It's "more than a physical symptom and isn't always resolved by curing the underlying condition," the IOM reports. "Persistent pain can cause changes in the nervous system and become a distinct chronic disease." Moreover, every individual experiencing pain experiences it uniquely. It can be influenced by genes, stress, depression, ability to understand health information and cultural attitudes.
And pain knows no barriers when it comes to age.
"Persistent and recurrent chronic pain is overwhelmingly prevalent in children and adolescents," according to Sara King, assistant professor at Mount Saint Vincent University in Nova Scotia, who led a group of researchers in what they billed as the first comprehensive study of pain in young people in 20 years. "Findings such as these argue that researchers and clinicians should be aware of the problem and the long-term consequences of chronic pain in children." Study results were published in the December issue of Pain, the journal of the International Association for the Study of Pain.
At the other end of the spectrum, of the 20 million emergency department visits made by Americans 65 and older every year, almost half are for the evaluation and treatment of acute pain. Nevertheless, a study published in the Annals of Emergency Medicine finds that people 75 or older are less likely to receive any pain medication in hospital EDs than people between 35 and 54 years old. "And these differences remained even after researchers took into account how much pain the patients were having," said Timothy F. Platts-Mills, M.D., lead author of the study and assistant professor of emergency medicine at the University of North Carolina at Chapel Hill School of Medicine.
"We're not exactly sure why this happens," Platts-Mills says. "It may be because physicians are more concerned about potential side effects in this population. To us, the gap we observe in pain management for older patients highlights the need to understand how best to manage pain in older patients and understand the barriers to doing this.
"All patients," he says, "regardless of age, deserve to have relief from pain, especially when it is severe."
Who would disagree? One of the first steps has to be overcoming ignorance among both patients and providers. Among the IOM's several recommendations:
• Health care organizations should take the lead in developing innovative approaches and materials to coach and empower patients in self-management.
• Training programs for dentists, nurses, physicians, psychologists and other health professionals should include pain education in their curricula and promote interdisciplinary learning.
Bill Santamour is managing editor of Hospitals & Health Networks.