America is a nation racked with pain that's too often unacknowledged and inadequately treated, a panel of experts reported Wednesday.
At least 116 million U.S. adults — about one-third of the nation's population — live with chronic pain. Along with its toll in suffering, chronic pain costs society an estimated $560 billion to $635 billion a year in medical bills and lost productivity, according to a report by the Institute of Medicine.
More people are in chronic pain than the combined number with heart disease, diabetes and cancer, the report said. The number of people who say they're in pain has grown steadily in recent years, and that trend is expected to continue as the population ages.
"It is morally unconscionable. We have 116 million people struggling every day with chronic pain. It is a moral duty of people in health care to address this issue," said Myra Christopher, president of the Kansas City-based Center for Practical Bioethics and a member of the 19-person panel that wrote the report.
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Pain treatment is hampered by inadequate training of doctors, insufficient insurance reimbursements and the negative attitudes of both doctors and patients toward people in pain, said the report, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research."
Along with a long list of specific recommendations for improving pain research and treatment, the report called for a "cultural transformation" in the way the public and medical professionals regard pain.
People may avoid seeking treatment out of a belief that pain has a divine purpose, or out of resignation that pain can't be alleviated, the report said. They may fear that complaining about pain will be seen as a sign of weakness.
"Many of us were raised to just suck it in and go on," Christopher said, adding that athletes are told "no pain, no gain."
Doctors sometimes trivialize their patients' experiences with pain, especially when their pain doesn't appear to be tied to an identifiable illness or injury.
"I hear doctors say, 'I have people come to my office and I feel they are trying to scam me,' " Christopher said. "Frankly, I believe chronic pain patients are suffering needlessly because of this confusion over drug diversion."
Pain's many forms
Pain takes many forms and has many causes. There is the acute pain of a traumatic injury, the throbbing head of a migraine, the excruciating nerve pain of shingles. Social and psychological issues — for example, the strain of poverty, depression or post-traumatic stress — can intensify how pain is experienced.
The latest research, cited by the report, finds that chronic pain can occur on its own long after an illness or injury is gone. The original pain may "rewire" the nervous system to respond with pain to the least stimulation, such as a light touch or gentle breeze.
"'It's not in your head' is a message we want to convey," said Philip Pizzo, dean of Stanford University medical school and chairman of the Institute of Medicine panel. "For many patients, chronic pain becomes a disease in its own right."
Pizzo said the report's estimate of the number of people in pain is conservative because it does not include children or military personnel.
Patients often go years without being adequately diagnosed or treated, the report said.
Jerry Medol, 68, started getting back pain at least 20 years ago. For the past decade he needed a cane to get around. But he decided to tough it out and didn't seek help until last year, when the pain became unbearable.
"The truth was I tolerated it. I lived with it," the Kansas City anger management instructor said. "I didn't realize how seriously, how profoundly my situation had deteriorated."
In October, he had surgery at the University of Kansas Hospital for pinched nerves in his back. In March, he had another operation to replace an arthritic hip. Now he's getting physical therapy and can walk unassisted.
"It's absolutely night and day," Medol said.
Roxanna Clemons, 51, of Topeka was stepping into her Jeep at a convenience store parking lot when it was rear-ended by another car. That accident in 2000 sent her to the emergency room with an injured leg and then to a series of doctors who couldn't ease her intractable pain. The once-active woman, who worked as many as four jobs at a time, was bedridden for years.
"I couldn't function. I was angry. I was upset. In a way, my life was taken away from me," Clemons said.
Ultimately, Clemons was referred to the pain clinic at KU Hospital, which provides wide-ranging treatments by doctors, psychologists, physical therapists and other care providers.
After fighting for insurance coverage for the procedure, Clemons' KU doctor, Talal Khan, implanted a device that sends electrical signals to her spinal cord. Now, most of the pain is gone. Clemons walks a mile each day for exercise and has lost about 75 pounds, much of that weight gained from taking pain medications.
"I wanted to get better and I got better," Clemons said. "I got my life back."