Meeting the Challenges of Public Health Issues in Chronic Pain

Faculty Perspectives in Chronic Pain: Solutions to Public Health Issues in Chronic Pain
Gary M. Owens, MD

Chronic pain is an issue of major importance for US payers. Although the management of chronic pain is complex and requires multiple medical interventions and therapies, one of the mainstays of treatment is the appropriate use of opioid therapy.1 In this regard, payers are tasked to maintain a balance that simultaneously maximizes the benefits of prescription opioids and minimizes the risks associated with their misuse and abuse.

Finding this balance is not only challenging for payers, it is also of major concern for physicians and their patients. In the main article in this publication, the author concludes that “...there is an urgent need for education and training of healthcare providers, patients, and the public at large, in addition to collaboration among all stakeholders, including policy makers, to provide optimal pain care.” Highlighting this urgent educational need is the fact that in 2010 there were 16,651 opioid-related deaths in the United States.2 Even more disturbing are the following facts: for every 1 death from prescription painkillers, there are 10 treatment admissions for abuse; 32 emergency department visits for abuse or misuse; 130 people with abuse or dependency issues; and 825 nonmedical users.3 These alarming statistics clearly show that concerted efforts are needed to combat this growing public health issue while preserving, and even expanding, appropriate treatment options for patients with chronic pain.

The main article also focuses on the educational gaps across multiple stakeholders. Regarding the issue of chronic pain, providers need to further their understanding of the magnitude of the problem and of the tendency for many patients to underreport pain. In addition, a one-size-fits-all solution for its management should be avoided. Physicians must be willing to become better educated about the various issues associated with chronic pain, including emerging strategies for its assessment and treatment, and the need for an interdisciplinary approach to care.

Patients also need to better understand the causes of their pain, as well as treatment options and reasonable outcomes based on the therapy they choose. According to the World Health Organization: “Health education focuses on building individuals’ capacities through educational, motivational, skill-building and consciousness-raising techniques….Health literacy is an outcome of effective health education, increasing individuals’ capacities to access and use health information to make appropriate health decisions and maintain basic health.”4 However, the challenge is to educate patients about the complexities of chronic pain, which may be a significant task for all parties involved. According to the Department of Health & Human Services, only 12% of US adults have proficient health literacy status and more than one-third of US adults—77 million people—have difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart.5 This reality will create substantial challenges for stakeholders who must develop effective patient-directed educational resources about chronic pain.

As already noted, payer organizations are an important stakeholder in the management of chronic pain. In this arena, payers can support opioid risk management by recommending clinician training about safe prescribing of opioids; encouraging patient education by clinicians; and creating and supporting the development of comprehensive educational materials for their members about chronic pain and available treatment options. Along these lines, it is important that payers help educate members about the appropriate use of nonopioid pharmacotherapy and nonpharmacotherapeutic approaches to the treatment of pain, as well as the safe and appropriate use of opioids.

By working in collaboration with all involved stakeholders to close these educational gaps—including clinicians, public health agencies, state and federal regulators, and pharmaceutical manufacturers—we will move one step closer to improving the management of chronic pain and eliminating the unintended consequences of opioid-related illness and death.

References

  1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. Washington, DC: The National Academies Press; 2011. http://books.nap.edu/openbook.php?record_id=13172&page=17. Accessed January 20, 2015.
  2. Centers for Disease Control and Prevention. Opioids drive continued increase in drug overdose deaths [press release]. www.cdc.gov/media/releases/2013/p0220_drug_overdose_deaths.html. Accessed January 21, 2015.
  3. Centers for Disease Control and Prevention. Policy impact: prescription painkiller overdoses. www.cdc.gov/homeandrecreationalsafety/rxbrief/. Accessed January 20, 2015.
  4. World Health Organization. Health education: theoretical concepts, effective strategies and core competencies. http://applications.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf. Accessed January 19, 2015.
  5. US Department of Health & Human Services. America’s health literacy: why we need accessible health information. http://www.health.gov/communication/literacy/issuebrief/. Accessed January 19, 2015.
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