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Prevalence of Chronic Pain Among Americans, And Its Cost… Results from the “American Productivity Audit,” presented at the IASP/10th 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. 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. 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 estimated17 million Americans were treated by pain clinics, centers, and solo practitioners such as chiropractors, anesthesiologists, and biofeedback therapists in 2009. Fully 13 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…
No license is needed to call oneself a pain specialist. Therefore, a wide variety of peoplemay tout themselves as pain experts. There are 12 states where no state prescription monitoring databases or tracking systems for powerful drugs such as Oxycontin and Oxycodone. It is these states, especially, Florida, that such pill mills flourish and operate with impunity. According to Edward Covington, a pain specialist at the Cleveland Clinic, multidisciplinary pain clinics are on the wane. There are no statistics, but Covington says he suspects their numbers have dwindled about 90% in the past 30 years. The problem is that a lot of patients just don’t like them. Insurance companies also sometimes balk at multidisciplinary clinics, which are costly. They’ll cover them, Covington says, but usually “only enough so they lose just a little bit of money on them every year.” Insurers say they sometimes have trouble determining how legitimate the clinics are or how much of a service they’ll provide, since there are no national guidelines for what the clinics should encompass. Apparently, the treatment of chronic pain is a relatively new field, since fully 43% of all pain clinics responding to Marketdata's first mail survey were founded during the 1984-86 period, with another 21% started during the 1970s. The oldest clinic was founded in 1960. 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. Our Forecasts… We believe that: * The number of “pill mills” will dwindle drastically over the next few years, as more of the 12 states with no prescription database and monitoring systems put them in place and the DEA continues to police mills and shut them down. * Due to ongoing pressure by insurers to rein in costs, there will be a shift toward greater usage of less costly, short-term procedures such as nerve blocks and epidural injections, performed primarily by anesthesiologists and other physicians in their offices, as well as the use of medications. Insurers usually prefer to pay for single therapies, like opioids, the narcotics that block messages in the brain and make patients care less about their pain. * We should see a shift toward more outpatient programs that are less costly. * The demand for chronic pain management will continue, as Americans age, coupled with wounded Veterans of the wars in Iraq and Afghanistan returning home and needing care. Rising obesity rates will also create pain issues for the overweight and obese. * Pain management programs will come under increased pressure to provide evidence-based outcome data to insurers. * We may see a shift toward more hospital-based pain management programs.
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