The Rampant Under-Treatment Of Pain

As I’m working on my forthcoming book, A Nation in Pain: Healing Our Biggest Health Problem (Oxford, 2013),  I’m also contributing to WBUR’s CommonHealth blog. The following entry first appeared on WBUR’s site.

There’s a dynamite piece in the Jan. 19 New England Journal of Medicine that I would urge anybody in chronic, severe pain to read.

It’s written by Dr. Philip Pizzo and Noreen Clark, who chaired the committee of pain specialists who wrote an important report last June for the Institute of Medicine, an arm of the National Academy of Sciences. Pizzo is dean of the Stanford University School of Medicine and Clark is director of the Center for Managing Chronic Disease at the University of Michigan.

Medical schools barely teach about pain, even though pain is the main reason people go to doctors.

In their New England Journal piece, and in the lengthy Institute of Medicine report itself, Pizzo and Clark argue eloquently that under-treatment of chronic pain is rampant in this country, that we have a “moral imperative” to do better and that many patients in severe pain understandably see their doctors as “poor listeners.” (I can vouch for this personally: The first doctor I saw during an 8-month bout of severe neck pain a few years ago suggested my pain was an emotional problem.)
As Pizzo and Clark say, “the magnitude of pain in the United States is astounding.” More than 116 million Americans live in some degree of chronic pain, and this figure doesn’t even include kids, people in the military or people in nursing homes. The cost is astounding, too: An estimated $560 to $635 billion, more than the costs of cancer, heart disease and diabetes combined.

For me, the most egregious problem is that, as the Institute of Medicine report documents, medical schools barely teach about pain, even though pain is the main reason people go to doctors. A Johns Hopkins survey of 117 medical schools last year showed that doctors learn appallingly little about pain in med school. Other data show that only half of primary care physicians feel even “somewhat prepared” to deal with patients in pain.

As a nationally syndicated health columnist, I have become so concerned about the chronic pain epidemic that I am writing a book on it for Oxford University Press and the International Association for the Study of Pain, an academic group.

As a journalist for almost 40 years now, I have watched with awe and deep respect as people with breast cancer, AIDS and disabilities have cast aside the stigma and isolation and insisted on more respect and better treatment. I think people with chronic pain — and those who love them — should do the same.