Chronic pain patients ill served by U.S. medicine

It is estimated that up to 66 percent of U.S. women and 45 percent of U.S. men live with chronic pain from spinal disorders like disc disease, pinched nerves and neck pain, to complex regional pain syndromes, fibromyalgia, irritable bowel syndrome, and headaches. Low back pain alone affects eight out of 10 people worldwide and is the fifth most common reason people visit a doctor.

Yet despite steroid and pain-killer injections, expensive and invasive treatments like spinal fusion, disc surgery, spinal cord stimulators, nerve ablation and the controversial opioid drugs, chronic pain is becoming worse in the U.S. adult population, not better.

The truth is, even though pain medicine is now a $300 billion a year business, it mostly offers only short-term solutions and short-term relief to patients, sometimes with considerable risks.

For example:

• Spinal surgery fails so frequently in resolving pain, it has created the medical term “failed back surgery syndrome.” No one has ever heard of “failed hip surgery syndrome” or “failed shoulder surgery syndrome” because they don’t exist. One study of Workers’ Compensation patients found the success rate after a second lumbar surgery was only 53 percent and after a third, 35 percent.
• Surgically-implanted spine stimulators, which control pain by exerting electrical signals, have been linked to migration of the leads, lead breakage, infection, unwanted jolting and shocking and more.
• Radiofrequency ablation, commonly called “nerve burning,” can cause infection, numbness and allergic reactions to contrast dye and burning sensations after the procedure. Despite destruction of the apparent offending nerves, pain can persist and migrate to new locations.
• Loosened guidelines and wider prescribing for opioid narcotics have not only created an unprecedented national addiction problem, over time, they can produce the very pain they are supposed to treat—a phenomenon called opioid-induced hyperalgesia.
• Medtronic’s highly promoted Infuse Bone Graft that was supposed to stimulate bone growth and replace damaged spinal disks during surgery turned out to be linked to side effects like paralysis, nerve damage, respiratory problems, excessive bone growth and worse. Congress found the company downplayed risks and side effects.
• In 2012, sealed vials of the steroid methylprednisolone used for spinal injections from compounding pharmacies spread a rare fungal meningitis that killed seven people and sickened 64 across nine states. In 2007, the journal Spine reported 78 injuries and 13 deaths from the injections prior to the fungal contamination.

Why is chronic pain worsening in U.S.?

There are three reasons why the $300 billion a year pain “biz” is ballooning: Aggressive advertising, a population that is aging and growing heavier and more sedentary and patients and doctors who too often believe that quicker and more dramatic treatments are always better. Even though the public accepts the necessity of hard work for positive results in sports, academia and most other fields, when it comes to chronic pain, Americans often want a quick fix, like narcotics, surgery, injections and implanted devices—not hard work.

Yet only twenty years ago, chronic pain was treated in a different and more effective way. Chronic pain patients used to receive the attention of a whole team of medical professionals, called a “multidisciplinary team.” The team would include a physiatrist (a doctor specialized in physical medicine and rehabilitation), physical, occupational, vocational, exercise and ergonomics therapists as needed, a social worker, psychologist, rehabilitation nurse and even support groups of other pain patients and clergy.

Of course, today insurers will not reimburse such treatment thinking it “too expensive.” Yet, when looking at long-term outcomes, repeated surgeries and re-hospitalizations, worker disability and opioid addiction, the upfront investment in multidisciplinary treatment is actually cost saving.

One reason multidisciplinary team treatment works so well for pain patients is it addresses both mind and body. Also, patients are part of the team and their opinions and input matter; in most pain treatments today, patients are passive and told what to do.

Yes, more people are suffering from chronic pain than ever and there are more treatments available. But it is not clear that pain patients themselves are benefiting.

Martha Rosenberg is an investigative health reporter. She is the author of Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).