Medical DirectorsBACKGROUND

The total cost of pain to the American economy each year is estimated to be between $85 billion and $90 billion. Individually, the average patient with chronic pain has had symptoms for seven years, has undergone three major medical procedures, and has generated medical bills between $50,000 and $100,000. Although multidisciplinary pain programs are generally regarded as the optimal form of treatment for chronic pain, they can be very expensive. A program that lasts from two to 10 weeks can cost more than $15,000. Compared with the expense of other chronic conditions, the annual costs associated with chronic pain exceed those related even to heart disease, hypertension, and respiratory disease.

The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual and potential tissue damage, or described in terms of such damage.” Persistent pain that lasts for six or more months—or that lasts longer than the typical recovery time for the disorder with which it is associated—is known as chronic pain. Because no biological markers of pain exist, the most accurate evidence of pain comes from patients’ descriptions.

Pain has become one of the leading health problems in the U.S. and is the foremost reason that people seek medical care. Pain is also the second leading cause of medically related work absenteeism, resulting in more than 50 million lost work days each year. The heightened awareness of pain and its clinical and economic sequelae has led the Department of Veterans Affairs to designate pain as a “fifth vital sign” that should be monitored along with blood pressure, temperature, pulse, and respiratory rate. The estimated prevalence of chronic pain in the general population ranges from 2% to 40%, and almost half of those persons affected are unable to obtain adequate relief. Depression, psychosocial stress, emotional distress, functional loss, social withdrawal, sleep disturbance, impaired ambulation, slow rehabilitation, and vocational dysfunction have all been associated with chronic pain.

Despite its high prevalence in the U.S. population, chronic pain is often mismanaged and misunderstood by health care professionals. One reason is the lack of adequate education about pain for physicians and nurses. In addition, patients, regulators of pain medications, and health insurers lack awareness of effective treatment options for chronic pain. Multi-disciplinary treatment strategies that include a biopsychosocial approach, along with pharmacological and nonpharmaco-logical interventions, have been shown to be effective in managing chronic pain.
buy antibiotics canada

Approximately 93% of working Americans and close to five million Medicare beneficiaries are enrolled in a health maintenance organization (HMO) or another form of managed care organization (MCO). The vast increase in the number of Americans covered by managed care plans in the past few years has made pain management a concern not only for patients but for MCOs as well. MCOs are finding that the problems associated with chronic pain affect costs even more than many other chronic disease states do. This economic strain will only grow larger if pain is not managed appropriately and efficiently. In addition to financial constraints, other barriers to implementing effective pain management programs include:

  • a lack of knowledge on how to assess pain and how to treat it with appropriate drugs and correct doses.
  • a fear that administering pain medication might cause patients to become addicted or might lead to respiratory depression.
  • a fear of exceeding regulatory standards.
  • a lack of time.

In addition, many MCO administrators have not endorsed multidisciplinary treatment of chronic pain because of a lack of well-controlled studies to guide appropriate treatment options.

One of the major roadblocks in the effective treatment of chronic pain is the absence of universal pain-management guidelines and a consensus on how to treat pain. Both the American Geriatrics Society and the American Pain Society (APS) acknowledge this problem and the limited availability of evidence-based literature on the assessment and management of chronic pain. Traditionally, the quality of care related to pain has varied in the managed care setting, resulting in a position statement by the APS intended to address the problem. buy cialis soft tabs

This statement supports health plans that “. . . implement systematic methods of pain assessment and management to facilitate quality care and to obtain reasonable outcomes for pain management activities.” To achieve this goal, the APS recommends (1) completing timely and effective assessments and referrals, (2) educating primary care providers, (3) cre-dentialing pain specialists, (4) distinguishing chronic pain from acute pain, (5) measuring quality and outcomes, (6) generating appropriate organization-specific clinical pathways and guidelines, and (7) communicating with all stakeholders in a patient’s care.

To date, no research has been done to determine the impact of this position statement or to describe systematically the state of pain management in the setting of managed care. Given the prevalence of chronic pain, its cost, and its quality-of-life implications, this study was undertaken to investigate the extent of chronic pain management activity currently taking place within managed care.