Managed care organizations (MCOs) must play a pivotal role in the management of patients with chronic pain. Payers already recognize that pain is one of the most prevalent chronic conditions and that it is generally associated with significant comorbidities. As noted in the main article in this publication, there may be greater than 100 million adults in the United States with some form of chronic pain.1 This number represents more than twice as many people as those who suffer from 2 of the most common chronic conditions (asthma and diabetes) combined.2,3 Chronic pain remains a growing problem in the United States, driven by many factors, including an aging population and increasing prevalence of osteoarthritis and low back pain in that population.4 Therefore, it is essential that MCOs focus on appropriate management of this increasingly important and costly sector of society.
The author of the main article points out that chronic pain may be underdiagnosed and, in many cases, undertreated. Additionally, it affects women and some ethnicities in a disproportionate fashion. From a payer’s perspective, these facts about the epidemiology and prevalence of chronic pain must be juxtaposed to other alarming and equally important facts. For example, in a study of greater than 36 million deidentified pharmacy claims from 6.8 million insured Americans of all ages who filled at least 1 prescription for an opioid to treat short- or longer-term pain from 2009 through 2013, Express Scripts found that nearly one-half of patients who took opiate painkillers for more than 30 days in the first year of use continued to use them for 3 years or longer. Furthermore, the study found that almost 50% of those patients were taking only short-acting opioids, putting them at higher risk for addiction.5 The investigators also found that nearly 60% of patients using opioids were taking a combination of drugs that are dangerous and potentially fatal. This correlates with data from the Centers for Disease Control and Prevention showing that overdose deaths involving pharmaceutical narcotics have increased dramatically. Starting with 4030 deaths in 1999, the number of deaths increased to 15,597 in 2009 and 16,651 in 2010, when nearly 60% of total drug overdose deaths (22,134) involved pharmaceutical drugs. Narcotics were involved in approximately 3 of every 4 pharmaceutical overdose deaths (16,651).6
Payers are faced with this dual reality surrounding the management of chronic pain. It is essential that MCOs have policies in place that prevent access to inappropriate use of potent narcotic medications, and they must monitor their populations for potentially dangerous combinations of drugs by their drug utilization review programs. It is through such efforts that abuse, misuse, and even deaths may be prevented.
At the same time, MCOs must help facilitate improved diagnosis and management of chronic pain. This will require them to develop programs that help educate their network physicians on how to recognize the diverse signs and symptoms of chronic pain, how to manage it appropriately, and when to refer patients for more specialized care. They must also develop case management programs to help patients navigate the complex medical environment that often comes with managing ongoing illnesses such as chronic pain and its associated comorbidities.
- 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 December 15, 2014.
- American Diabetes Association. Statistics about diabetes: data from the National Diabetes Statistics Report, 2014 (released June 10, 2014). www.diabetes.org/diabetes-basics/statistics. Accessed December 15, 2014.
- Centers for Disease Control and Prevention. FastStats: Asthma. Updated July 14, 2014. Accessed December 15, 2014.
- Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain. 2010;11:1230-1239.
- Express Scripts. A Nation in Pain. December 2014. http://lab.express-scripts.com/publications/a-nation-in-pain. Accessed December 15, 2014.
- Centers for Disease Control and Prevention. Opioids drive continued increase in drug overdose deaths [press release]. February 20, 2013. www.cdc.gov/media/releases/2013/p0220_drug_overdose_deaths.html. Accessed December 15, 2014.