Powerful painkillers like vicodin or percocet relieve pain but aren't intended to treat patients long-term. And many physicians are reluctant to prescribe them for fear of the pills getting into the hands of painkiller addicts, not to mention the legal consequences they could face.
"If you can't find an explanation for the pain, then you're reluctant to prescribe medications and have them become an ongoing long-term treatment plan," said Dr. Glen Stream, president of the American Academy of Family Physicians. "The challenge is trying to sort out who's in pain and who potentially is drug-seeking. There's a lot of pressure on physicians to be vigilant in their prescribing. We try to balance that with the desire to not have people suffer needlessly."
How to fix America's pain problem? The issue "will require a cultural transformation in the way clinicians and the public view pain and its treatment," Pizzo and Clark said in an editorial published today in the New England Journal of Medicine.
According to the IOM report, the transformation should start in medical schools. Doctors say medical students and current professionals are woefully undereducated in how to treat patients in pain. In a survey of 117 medical schools, only a handful reported including even a few lessons on pain for their students. The problem is large enough that several states have ordered currently practicing doctors to get a certain amount of additional training in chronic pain management.
Although there are doctors who specialize in treating chronic pain, their numbers are too few to care for every patient. The IOM reports that there are fewer than 4,000 pain specialists in the U.S.
Other changes will have to reach deeper into the U.S. health care system. Doctors say the current system of medical reimbursement doesn't allow them to spend a long time with patients treating illnesses that are not easily defined on a medical record.
"Physicians need to be empowered to take time and listen to their patients," said Dr. Doris Cope, director of the Pain Medicine Program at the University of Pittsburgh Medical Center. "Unfortunately, the way the medical system works today, everything is very mechanized and is supposed to fit into a box. But patients are unique in their pain and suffering."
And then, there's overcoming the notion that medical help must always come with a pill or under the knife. The IOM report recommends that patients use a variety of medical tools to confront their pain, including physical therapy, rehabilitation, even alternative treatments like meditation.
Hester said she found the greatest relief in holisitic treatments and physical therapy. She does exercises for about 45 minutes each day and sees a doctor three days per week for spinal decompression and physical therapy. The treatments help, but they are not covered by her medical insurance, so she and her husband are using the money they had saved for a downpayment on a house to cover the costs of her care – about $23,000 in the last year alone.
"It's hard to force yourself to get up and be active, to say, I'm going to get out and at least walk today, take all my supplements, do all my therapies," Hester said. "It does interfere with life. I'm trying really hard not to let it."