What is pain management?

To start us off, let’s take in a simple statistic. The National Institutes of Health currently estimates the US economy loses more than $100 billion per year on healthcare expenses, lost productivity and lost earnings caused by chronic pain. People in serious pain cannot go to work and take up time in the healthcare system. By a curious coincidence, the estimated cost of the healthcare reform currently working its way through the Washington mill is less than $100 billion per year. That’s why more than 75 millions Americans could do with a reversal of the current approach to pain. All the main lobbying power going into efforts to block reform supports the idea of maximum profit for minimum effort. That means doctors peddle pills as the first response treatment and discourage those in pain from seeking access to proper support services. OK, so just what are these “proper” support services?

Pain is a symptom of an underlying health problem. It can be an injury or the result of a disease. The first step is therefore a full diagnostic exercise to positively identify what is causing the pain. It’s no use trying to guess whether you do or do not have, say, a herniated disk. There are tests that can say definitively what the problem is and so point directly at the recommended treatment. In the case of a herniated disk, this would be a steroid injection and physical therapy. As with any service, it’s a case of matching resources and needs. Once you have a diagnosis, you can say whether a hospital should perform surgery or apply one of the other interventional procedures. Fully informed decisions can be made on which drugs to use and at what dosages. As it is, patients are left as a continuing experiment to try different drugs at different dosages and report back on pain levels. In appropriate cases, there can be reference to physical therapy or, sometimes more effective, psychological counseling, cognitive behavioral therapy and support services. All this before we get to the alternative therapies including acupuncture. Why all these different options? Because, people are complicated and do not fit into convenient treatment boxes. Everyone deserves to be treated as an individual with the right treatment given by the appropriate specialist.

Progress to persuade hospitals and clinics to set up pain management services is slow. These for-profit organizations do not believe they make a sufficient return on the cost of labor to justify creating a comprehensive department, bringing all the specialisms together. Change will only come when the politics of healthcare advances past the question of capitalism and makes the patient the center of attention. Until then, the best we can hope for is good medication. When it comes to the relief of moderate to severe pain, we are fortunate to have tramadol available. This is an opioid and so offers much the same level of relief as the opiates but with fewer adverse side effects. If you cannot prevail on your health insurance company to pay for “proper” pain management, you can console yourself with the best of the medications. Buy tramadol, write to your congressman and hope better days will come on the pain management front.