Chronic pain: An epidemic in America

By James Lehman

Chronic pain is a significant public health problem in the United States. It reduces quality of life and is, in part, responsible for the opioid epidemic the nation currently faces.

Last May, the Office of the Assistant Secretary for Health and the National Institutes of Health (NIH) of the U.S. Department of Health and Human Services hosted “Implementation of the National Pain Strategy (NPS) Listening Session,” where they outlined how practitioners and others can begin to address chronic pain issues.

The 2011 report written in collaboration with the NIH and the Institute of Medicine (IOM) called for “cultural transformation in pain prevention, care, education, and research and recommended development of “a comprehensive population health-level strategy” to address these issues” to address chronic pain.

Patients who experience pain have different levels of coping skills, which might be more challenging to treat than the pain itself. I, personally, am the typical, post-trauma, chronic pain patient, having experienced a motor vehicle accident in the 1980s. Following a multiple car impact that fractured seven teeth, ruptured two cervical discs, and sprained my spine and upper extremities, I now experience recurrent painful episodes that require treatment. Fortunately, at the time of my injuries, I owned my own business, completed my doctoral training, and enjoyed a supportive family and staff at my clinic. I have the resources and support to cope with the chronic pain, even as I continue to age, and the degenerative changes likely cause exacerbations of arthritic pains, nerve compression conditions, and the need for more care.

When I ask a classroom of chiropractors to define “chronic pain,” there are various answers with some similarities regarding the duration of pain but never complete agreement. It is rare that the doctors claim to be aware of the most current definition of chronic pain. In fact, even the Federally Qualified Health Center that I am credentialed to provide chiropractic services for chronic pain uses a different definition than the one offered by the National Pain Strategy.

Subsequent to the 2011 Institute of Medicine report, the National Pain Strategy released the definition of chronic pain, which I teach to doctors enrolled in the University of Bridgeport’s Neuromusculoskeletal Medicine program. It says chronic pain is defined as “pain that occurs on at least half the days for six months or more.”

Since I experience daily pain for more than 30 years, I qualify for this diagnosis of chronic pain. It is my opinion that chronic pain enables me to better comprehend the pain my patients endure during their lives.

My work as a chiropractic orthopedist focusing on the evaluation and management of chronic pain patients within Federally Qualified Health Centers permits me to offer non-pharmacological treatment to chronic pain patients rather than opioids. It also allows me to continue learning more about this chronic pain epidemic that is costing our country up to $635 billion per annum, more than heart disease, diabetes, and cancer combined.

The opportunity to be credentialed as a member of the primary care team and receive chronic pain referrals has been an enlightening experience. I have learned that not all of my patients respond to treatment for chronic pain as I do. For many of my patients, the chronic pain is disabling because of their biopsychosocial situations and then an illness in its own right. This I learned from a report funded by the Mayday Foundation.

Acute pain usually goes away after an injury or illness resolves. But when pain persists for months or even years, long after whatever started the pain has gone or because the injury continues, it becomes a chronic condition and illness in its own right.

I have also learned that a more convoluted type of chronic pain exists, one that limits work activities and impairs quality of life. As stated in the Call to Revolutionize Chronic Pain Care in America, the chronic pain syndrome becomes a chronic pain illness.  The National Pain Strategy has coined this illness as “High-Impact Chronic Pain.”

References

Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006.

Schappert SM, Burt CW. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 2001–02. Vital Health Stat 13 2006; 13:1–66.

Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K. The impact of chronic pain in the community. Fam Pract 2001; 18:292–9.

Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press; 2011.   

The National Pain Strategy. Available from: https://iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf

Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K. The impact of chronic pain in the community. Fam Pract 2001; 18:292–9.

The National Pain Strategy. Available from: https://iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf

Data on specific disease burdens is available from the Center for disease Control and Prevention’s

FastStats website available from: http://www.cdc.gov/nchs/fastats/. The burden of pain is available from: http://www.cdc.gov/nchs/data/hus/hus06.pdf.

A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform. The Mayday Fund. November 4, 2009. Amended March 4, 2010.