By John Tierney

Chronic pain affects more than 70 million Americans, which makes it more widespread than heart disease, cancer and diabetes combined. It costs the economy more than $100 billion per year. So why don’t more doctors and researchers take it seriously?

That is the challenge raised by a new report from the Mayday Fund, a nonprofit group that studies pain treatment. The report, which been endorsed by an array of medical groups, advocates a revolution in the training of doctors, the financing of research and the education of law-enforcement officials.

“The fact is that people aren’t getting competent and cost-effective treatment for chronic pain,” said Dr. Russell Portenoy, one of the co-chairmen of the panel that prepared the report.

Dr. Portenoy, the chairman of the department of pain medicine and palliative care at Beth Israel Medical Center, was one of the pain experts who supported William Hurwitz, the Virginia doctor who was imprisoned for prescribing opioid painkillers to patients who resold them. (Dr. Hurwitz’s sentence was reduced after a retrial in which Dr. Portenoy and other experts testified on his behalf.)

At a news conference Wednesday, Dr. Portenoy and the other co-chairman of the Mayday panel, Dr. Lonnie Zeltzer of the University of California, Los Angeles, said patients’ needs had to be better balanced against the concerns of law-enforcement officials, whose prosecutions of Dr. Hurtwitz and other doctors have made physicians reluctant to prescribe opioids. Dr. Zeltzer said doctors were especially reluctant to prescribe such painkillers to young people, and she cited the example of a teenager who had been incapacitated for six months until finding a doctor willing to prescribe opioids.

“Don’t assume that your doctor knows what to do to treat your pain,” Dr. Zeltzer advised patients.

She and the other members of the panel urged better pain-management training in medical schools and more money for pain research, which, according to the report, receives 1 percent of the budget of the National Institutes of Health.

The panel also urged the federal Department of Health and Human Services to reform the way doctors are reimbursed for treating pain. Dr. Portenoy said that the current system had “misaligned incentives” encouraging doctors to preform procedures like injections and surgery and that doctors who performed those procedures could make 10 times as much per hour as doctors who treated pain in other ways.

Distorted incentives and inadequate treatment are hurting patients at the same time they are driving up health costs, according to the report:

Instead of receiving effective relief, patients with persistent pain often find themselves in an endless cycle, seeing multiple health care providers, including many specialists in areas other than pain, who are not prepared to respond effectively. They often endure repeated tests and inadequate or unproven treatments. This may include unnecessary surgeries, injections or procedures that have no long-term impact on comfort and function. Patients with chronic pain have more hospital admissions, longer hospital stays and unnecessary trips to the emergency department. Such inefficient and even wasteful treatment for pain is contributing to the rapid rise in health care costs in the United States.

You can read the rest of the Mayday report and its recommendations here. Do you have any recommendations on what should be done, and any guess as to the likelihood of reforms in the treatment of chronic pain?

http://tierneylab.blogs.nytimes.com/2009/11/05/treating-the-pain-epidemic/?ref=science