Pain Overview

Overview of Pain in America

Prevalence of Chronic Pain Among Americans, And Its Cost…

Results from the “American Productivity Audit,” presented at the IASP/10^th World Congress on Pain in 2002, provided the first direct estimates of LPT from these pain conditions. Researchers found lost productivity time — i.e. work absence and reduced performance at work-averaged 5.9 hours per week for arthritis, 5.8 hours per week for back pain, 3.6 hours per week for headache, and 6.6 hours per week for other musculoskeletal pain. Extrapolating to the US workforce, researchers reported the preliminary estimated cost of these common pain conditions to employers was approximately $80 billion per year.

It has been estimated that 21.7% of adult Americans, or 34 million people, experience mild to moderate chronic pain to the degree that they seek relief from a physician. Pain is the second most common reason people visit physicians - topped only by colds and upper respiratory infections.

The National Institutes of Health claims that 40 million Americans are unable to find relief from their pain, which is chronic. Other sources say the right figure is 50 million. Marketdata thinks that the smaller numbers are probably closer to reality, but there is obviously a difference of opinion as to which number is more accurate, depending on which study you use.

For example, an excellent study was conducted in January 1999 for the American Pain Society by Janssen Pharmaceutica and The American Academy of Pain Medicine (research performed by Roper Starch Worldwide). The name is: Chronic Pain in America: Roadblocks to Relief.

One of the more significant findings of this study was that it is estimated that 9% of the U.S. adult population suffers from moderate to severe non-cancer related chronic pain. However, a newer Prevention Magazine/CBS News poll found that 12% had been diagnosed with chronic pain. As of 2000 population estimates available from the government, there were 209 million adults in the nation (aged 18+). This would mean, using the Janssen study as a guide, that there are approximately 18.8 million chronic pain sufferers in the United States. Even if one considers the TOTAL population (292 million), this only equals 26.3 million.

Chronic pain sufferers seek treatment because they are unable to perform daily activities, sleep, work, exercise, or concentrate. Because of chronic pain, one-third of sufferers are not able to work or perform routine activities for one out of every three days of the year. Of the people suffering from chronic pain, 60% are women.

An estimated 9 million Americans were treated by pain clinics, centers, and solo practitioners such as chiropractors, anesthesiologists, and biofeedback therapists in 2002, up from 7.9 million in the year 2000. Fully 7.1 million of these people are treated by anesthesiologists, mostly on an outpatient basis. No doubt, many more are in need of treatment but don't receive it due to inadequate health insurance, denial of treatment by their insurers, ignorance of available facilities, etc.

Nature & Development of The Field…

Apparently, the treatment of chronic pain is a relatively new field, since fully 43% of all pain clinics responding to Marketdata's first 1992 mail survey were founded during the 1984-86 period, with another 21% started during the 1970s. The oldest clinic was founded in 1960. Of some of the more well-known programs, the Mensana Clinic was founded in 1978, the Pain Control & Rehabilitation Institute of Georgia moved into private practice in 1985, and the New York Pain Treatment Program at Lenox Hill Hospital was founded in 1984.

Like any new specialty, pain programs are experiencing "growing pains" regarding acceptance, effectiveness, and a lack of hard scientific data and research. At the same time, as a growing field, it frequently attracts many less-than-ethical or qualified practitioners.

Many physicians simply don't have adequate training in effective pain management therapies. Acute pain, the kind caused by injuries, which is short-lived and doesn't recur for years, is easier to treat via drugs and known therapies. Chronic pain, however, is a far more complicated area which has not been part of the typical medical school education.

The Image Problem: While pain centers have emerged at hospitals to deal with acute pain patients, and some have sprung up to treat cancer pain, chronic pain is usually handled by freestanding clinics where the methods and effectiveness varies greatly. Patients may be shuffled from one specialist to another with no improvement. As a result, many insurance firms are reluctant to pay and frequently handle coverage on a case-by-case basis. Insurers are also wary of claims for chronic pain treatment because of the potential for addiction to pain medications by patients and abuse or incompetence by practitioners.

Even a university affiliation does not guarantee that a pain clinic can provide good care. Pain programs in 2003 still have a lack of hard data to support their claims of efficacy. Many practitioners, especially at the larger multidisciplinary pain clinics, claim that smaller, non-accredited clinics may lie about their outcome studies, and they very often cannot document the efficacy of their programs. However, it should be noted that some large, well-respected clinics are not accredited, and some small ones are. Lack of accreditation does not necessarily mean that the clinic is not good.

No license is needed to call oneself a pain specialist. Therefore, a wide variety of people may tout themselves as pain experts.

Some in the field charge that disreputable pain clinics make no effort to accurately diagnose their patients, putting all of them through a "cookie cutter" program, where all patients receive physical therapy, for example.