Pain "is the leading health problem in America today," the aptly named Dr. Richard Payne, president of the American Pain Society, said at a news conference to kick-off a series of radio and television ads, set to begin running in October, designed to increase awareness about the pain crisis.
"There is no other medical condition that is as costly," said Payne, who is chief of the pain and palliative care service at Memorial Sloan-Kettering Cancer Center in New York City.
Despite the severity of the problem, chronic pain does not attract the headlines of other conditions, such as AIDS and heart disease, and even the medical profession mostly ignores it, the pain specialists said.
One of the biggest barriers to caring for patients properly is a lack of education among physicians about how to manage and treat pain effectively, said Dr. Marc B. Hahn, dean of the Texas College of Osteopathic Medicine at the University of North Texas Health Sciences Center in Denton.
Hahn, representing the American Academy of Pain Medicine, said only 3 percent of U.S. medical schools offer a course dedicated to pain management and only nine faculty members in the whole country cite pain medicine as their primary specialty.
As a consequence, patients suffering from severe, crippling pain from various medical conditions often cannot obtain adequate treatment because most doctors have not acquired the knowledge or skills to deal with such patients.
Mary Vargas, an attorney in Washington, D.C., who suffered chronic neck and head pain after an automobile accident, described how she went through 13 physicians and endured nearly 30 procedures over a five-year period "before I even had a diagnosis." The pain was so severe Vargas found it difficult to function and carry out daily activities. Ultimately, she underwent a procedure to implant a stimulator in her spine, which has helped control her pain and allowed her to resume a fairly normal life.
Chronic pain can stem from a variety of conditions, including trauma, surgery, arthritis, cancer, back and neck disorders and migraines. The persistent pain from these conditions can be debilitating, destroying people's lives and careers and taking away the joy of living, said Dr. Joel R. Saper, director of the Michigan Head Pain and Neurological Institute in Ann Arbor. It can lead to a sense of desperation and isolation and even suicide, he said.
Compounding the lack of physician training is the reluctance of insurance companies to cover pain treatments, Saper continued. "Millions of patients are denied access to experts and advanced treatments that could alter their lives" because insurance companies often refuse to cover these services, he said.
"Insurance companies are brutal on pain patients because pain can't be proven," so they claim the treatments are unnecessary and deny coverage, Saper told United Press International. "I spend almost every day of my life fighting insurance companies," he said.
Congress is aware of the problem and has declared this the Decade of Pain Control and Research, but the legislative body looks unlikely to do anything significant soon to address the problem. Representative Mike Rogers, R-Mich., has introduced a bill in the House called the National Pain Care Policy Act, which seeks to improve pain treatment, but it does not look likely to pass this year and as yet there is no companion bill in the Senate.
Rogers, whose brother Charles suffers from chronic pain and has struggled to find satisfactory treatment, called pain "the largest significant health problem facing America that's unaddressed."
Despite the small chance Congress will pass any significant pain legislation this year, Rogers said he is not deterred and remains committed to improving pain treatment. If his bill fails to pass this year, Rogers plans to reintroduce it in 2004. "I'm like a bad rash ... I'll keep coming back year after year," he said.
Rogers' bill would authorize $61.5 million annually for three years to establish a National Center for Pain and Palliative Care Research. The center would be located at the National Institutes of Health in Bethesda, Md., and would foster research into effective pain treatments. The legislation also would authorize construction of six regional pain research centers and help disseminate information to physicians and patients about the best ways to treat pain.
Although development of more effective pain medications with fewer side effects would be ideal, Payne said currently available treatments in the hands of skilled physicians can keep most patients' pain under control. "If we just apply what we know now, we could make a big impact," he said.