Pain is considered by far the most common chronic ailment in America. It’s more common than diabetes, depression and high blood pressure. According to a new study published in JAMA Network Open, chronic pain today is the most common long-term health condition experienced by U.S. adults.
Some of you may recall my column a few weeks ago on this very topic. There is much more that needs to be said on a subject that the National Institutes of Health estimates costs this country between $560 billion and $635 billion a year. As reported on the Enlightened Mindset website, “This includes direct costs such as medical expenses, lost wages, and disability payments, as well as indirect costs such as decreased productivity and absenteeism.”
Even though the National Institutes of Health alone “has spent more than $600 million since 2020 on pain research” to better understand the biological mechanisms that underlie our ability to feel pain — including finding better treatments — debilitating pain continues to prevail as a serious problem for far too many Americans.
Beginning in December 2022, USA Today published a five-part series exploring the health issue of chronic pain, the challenges of treatment and the state of scientific advances. What reporter Karen Weintraub discovered was that “At least 1 in 5 (Americans) live with chronic pain. Some experts put the figure at 100 million (people).”
“Nearly 1 in 10 are disabled by it,” writes Weintraub. “On any given day, almost half of working-age men who are not in the labor force take pain medication, and people with chronic pain miss nine more days of work a year than those without it.”
Jeffrey Mogil, who studies pain at McGill University in Montreal, points out that research shows women to be more sensitive to pain than men. “The evidence is as close to incontrovertible as anything gets in biology.” Weintraub reports that “About 70% of chronic pain patients are women.” It is also pointed out that current treatments and drug development don’t consider gender differences.
Says Dr. John Mafi, a primary care doctor and associate professor of medicine at the David Geffen School of Medicine at UCLA, he high amount of pain that Americans experience has a lot “to do with just poor general health in our country.” There are many of our fellow Americans today who have never known life without pain. It is why there exists an “urgent scientific imperative to expand our tools to fight pain,” says Dr. Helene M. Langevin, director of the National Center for Complementary and Integrative Health, one of the 50 experts that Weintraub interviewed.
Among the other experts interviewed is Dr. Tina Doshi, a pain expert at the Johns Hopkins University School of Medicine. According to Doshi, “The vast majority of chronic pain patients will have stories about providers who have been dismissive,” Weintraub reports. “They are told their pain is imagined, all in their head. But advanced brain imaging has shown that those with chronic pain have clear differences in their brain activity.”
“They’re not making it up. This is not a psychological disorder,” adds Dr. Clifford Woolf, a neurobiologist at Boston Children’s Hospital. “Their nervous system is malfunctioning or there’s a chronic, persistent pathology which is driving the pain.” The pain these folks are suffering with is often unrelenting.
Alex Bryson is a University College London researcher who helped lead a studyfollowing a group of infants from their birth 65 years ago until now. It showed that painlater in life can be predicted from pain in childhood: “Where you were in your pain journey a long time ago continues to affect your life course in an adverse way.”
The experts also stress the importance of acknowledging that “The opioid epidemic is inseparable from the pain crisis.” While current statistics are not available, many now believe opioid addiction has increased during the COVID-19 pandemic.
“People often start taking the painkillers on a doctor’s order, after a surgery or an injury, and then need more and more to get the same benefit,” says Weintraub. “Millions of people (are) prescribed … opioids for pain from sports injuries and other seemingly short-term sources of pain, began taking the drugs long-term, needing more and more to receive the same amount of pain relief.” And Weintraub says that according to Mafi, “Opioids are properly used as third-or-fourth-line therapies in patients who cannot function normally without chronic pain relief.”
“At least 100,000 people died from drug overdoses last year, most of them from opioids, a dramatic increase from five years earlier,” reports Weintraub. The problem is that nothing else currently exists that is as effective at treating excruciating pain.
At the same time, there is another public health crisis brewing in the area known as “undermanaged pain,” a situation made worse by what Robert Kerns, an expert in chronic pain at Yale University, describes as “every drugstore in America (having) an entire aisle devoted to painkillers …This is a very serious public health concern.”
“All pain medications, including opioids, over-the-counter painkillers and nerve blockers, blunt but don’t erase suffering,” writes Weintraub. “They often become inadequate over time or even contribute to the cycle of pain and desperate search for relief. Misused, every drug treatment can destroy organs and lives.”
A look at the state of pain treatment in this country today “should depress anyone,” Mogil proclaims to USA Today.
Says Carmen Renee Green, dean of the CUNY School of Medicine, the zero to 10 scale doctors use for patients to rate their pain “makes great sense for clinicians, but it doesn’t work well for patients in many, many cases,” and that is often true for “those who have traditionally received substandard medical care”, writes Weintraub
“All those histories come into how we perceive pain, how pain is assessed and how pain is treated,” Green concludes. “We’ve got to do better.”