Patients who use opioids to treat legitimate intractable pain typically have exhausted all other modalities. The pursuit of a non-opioid treatment options, complementary modalities or “conservative treatment” can lead to medical bankruptcy and/ or medical complications including loss of career, home, treasured relationships and other significant losses before the use of opioids are implemented, and only after all other treatment modalities are thoroughly exhausted.
The prevalence of pain underlines why preserving individualized patient care is so crucial. Including the use of opioid therapy to manage acute, chronic and intractable pain.
National Health Interview Survey
The National Health Interview Survey 2012 (NHIS) states that 25 million people in the United States suffer from chronic pain.
The Center for Disease Control (CDC)’s NHIS is an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences.
The 2012 NHIS asked participants about the frequency and intensity of pain experienced in the prior 3 months. The survey results are based on combined data from 8,781 American adults from a subsection of the larger NHIS.
Researchers assigned pain severity using an approach developed by CDC investigators working with the Washington Group on Disability Statistics, which provides four categories of pain.*
Among the findings of the analysis:
- An estimated 23.4 million adults (10.3 percent) experience a lot of pain.
- An estimated 126 million adults (55.7 percent) reported some type of pain in the 3 months prior to the survey.
- Adults in the two most severe pain groups were likely to have worse health status, use more health care, and suffer from more disability than those with less severe pain. However, approximately half of individuals with the most severe pain still rated their overall health as good or better.
- There were associations between pain severity and race, ethnicity, language preference, gender, and age. Women, older individuals, and non-Hispanics were more likely to report any pain, while Asians were less likely.
- Minorities who did not choose to be interviewed in English are markedly less likely to report pain.
- The impact of gender on pain varies by race and ethnicity.
This report begins to answer calls for better national data on the nature and extent of the pain problem,” said Richard L. Nahin, Ph.D., M.P.H., lead epidemiologist for NCCIH and author of the analysis.
The experience of pain is subjective. It’s not surprising then that the data show varied responses to pain even in those with similar levels of pain. Continuing analyses of these data may help identify sub-populations that would benefit from additional pain treatment options.
Americans Are Still in Pain
In 2015, NIH introduces a new analysis of the 2012 NHIS information that further addresses the prevalence of pain by stating:
“The study found that an estimated 25.3 million adults (11.2 percent) experience chronic pain—that is, they had pain every day for the preceding 3 months.
Nearly 40 million adults (17.6 percent) experience severe levels of pain. Those with severe pain are also likely to have worse health status.
The analysis was funded by the National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) and was published in The Journal of Pain.
The number of people who suffer from severe and chronic pain is striking,” said Josephine P. Briggs, M.D., director of NCCIH. “This analysis adds valuable new scope to our understanding of pain and could inform the National Pain Strategy in the areas of population research and disparities. It may help shape future research, development, and targeting of effective pain interventions, including complementary health approaches.
Read more about the 2012/ 2015 NIH reports.
To summarize, 126 million patients experience ongoing pain for 3 months consecutively in a one year time frame.
There are 25-40 million people who suffer chronic pain and require long-term intervention.
Intractable pain does not go away, and it can be fatal in some cases, if it is left untreated.
The CDC has initiated “voluntary” guidelines about the prescribing of opioids by primary care physicians, but those guidelines have become draconian policy, mandates that erode the patient-physician- pharmacist relationship.
For these reasons, our collaborative group supports patients experiencing all forms of pain and their healthcare providers to provide an individualized plan of care.
We believe that long-term healthcare decisions should not be unduly influenced by special interests, government agencies or policy makers.
The decision to add opioids to an individualized plan of care is implemented only after the patient experiences a significant decline in function and productivity. Opioids to treat chronic and intractable pain are administered by medical professionals who currently utilize strict guidelines and stringent oversight, with an emphasis for patients to regain their mobility, function, participate in their activities of daily living, and restore quality of life.
A prohibition of opioids will not stem the tide of illicit Fentanyl from streaming over the United States (US) borders nor, will it stop unintended overdoses.
However, opioid prohibition will prevent millions of patients from successfully participating in their daily lives at their fullest capacity preserving their quality of life.
With that said, we are not callous to the significant loss of life for those who have lost their lives due to illicit opioids flooding across the borders into our country, and we offer our sincere condolences to everyone who has experienced such sorrowful tragedy.
High Impact Chronic Pain
From a study published by ncbi.nlm,nih.gov by Pitcher, Von Korff, Bushnell and Porter “Prevalence and Profile of High-impact Chronic Pain in the United States ” published August 2018 states:
“Overall, chronic pain, defined as pain experienced on most days or every day in the previous 3 months, was strongly associated with an increased risk of disability after controlling for other chronic health conditions (odds ratio = 4.43; 95% confidence interval = 3.73-5.26), where disability was more likely in those with chronic pain than in those with stroke or kidney failure, among others. HICP affected 4.8% of the U.S. adult population, or approximately 10.6 million individuals, in 2011.
The HICP population reported more severe pain and more mental health and cognitive impairments than persons with chronic pain without disability, and was also more likely to report worsening health, more difficulty with self-care, and greater health care use.”
Chronic pain continues to impact millions of patients, high impact or not.
Center for Disease Control (CDC) 2016 Opioid Prescribing Guidelines
Due to the CDC’s opoid prescribing healthcare policy changes, many patients experiencing pain have lost access to the only treatment that is effective to relieve their pain.
Patients are reporting they are being forced to taper medications. They also report being unable to refill their opioid prescriptions at pharmacies. Physicians are implementing drastic measures based on “following” the Center for Disease Control Guideline restrictions on prescribing opioids.
Medical care is not consistent across states as legislators rush to implement even more restrictive legislation curtailing prescribing limits than originally suggested by the CDC only further eroding continuity of care for patients.
The CDC guidelines were never originally intended to impact patients with chronic or intractable pain. The new guidelines were voluntary and aimed at primary care physicians, not pain management physicians.
As it stands now, niether primary physicians or pain management physicians want to care for patients with intractable pain because they are viewed as a “liability” secondary to a hostile regulatory environment, not because patients don’t require treatment for pain, including opioid therapy.
The implementation of these new guidelines have created a snowball effect. This resulted in both primary care and pain management physicians rapidly “dumping patients” who are prescribed opioids, out of sheer concern for their license and assets, as the US Drug Enforcement Agency (DEA) wages a failed drug war on the community.
Healthcare providers have been made “examples of” by the Drug Enforcement Agency (DEA), by arresting and prosecuting > 500 physicians for failing to follow the CDC’s 2016 Opioid Prescribing Guidelines.
Even prosecuting physicians, retrospectively.
The idea of “voluntary compliance” seems to have been lost in the “opioid hysteria.”
Our opinion is that the CDC guidelines are based on flawed research, driven by special interests and by DEA over-reach.
Pain management, prescription opioid mortality, and the CDC: is the devil in the data?
In the “Journal of Pain Research” Dr. Michael E Schatman and Dr. Stephen J Ziegler detail how the CDC failed to utilize reliable data by stating:
Transparency, freedom from bias, and accountability are, in principle, hallmarks of taxpayer-funded institutions. Unfortunately, it seems that at least one institution, the Centers for Disease Control and Prevention (CDC), continues to struggle with all three. What began with a prescribing guideline created in secrecy has now evolved to the use of statistical data and public statements that fail to capture not only the complexity of the problem but also the distinction between licit and illicit opioids and their relationship to the alarming increase in unintentional overdose. This is unfortunately consistent with Mark Twain’s assertion that “There are lies, there are damn lies, and then there are statistics.”1Journal of Pain Research
Pain management, prescription opioid mortality, and the CDC: is the devil in the data?
Michael E Schatman and Stephen J Ziegler
Additional article information
A narrow mainstream media narrative and public hysteria also has contributed to a negative outcome for patients.
This combination has resulted in a failed drug policy that has created “pain refugees” being “dumped” by their healthcare providers leaving them with few, if any treatment options for their pain.
The guidelines were implemented without sufficient planning or viable options for the pain community to turn to for alternative treatments that are effective.
Let’s clarify, efficacy equal to the effectiveness of opioid therapy for analgesia. There are a lot of faux designer patented drugs out there, but they are expensive, fraught with side effects, and often they don’t work.
These issues are further magnified by extreme healthcare bias, discrimination, marginalization, and social stigma based on misinformation about the complexity of the pain phenomena.
Pain is now the “new leprosy!”
Actually, pain patients are now, the “new minority.”
Chastised, abandoned, silenced and marginalized.
Consequences to a Failed Drug War
Competent pain management physicians are leaving their practice in fear of losing their license and having their assets seized for prescribing opioids.
This “intended or unintended consequences or outcome is leaving a wake of “pain refugees” without sufficient access to medical care or pain relief.
Events are unfolding as waves of unwarranted hardship impacting stable patients, and their healthcare providers come to light.
There is no justification for unethical and inhumane treatment of patients in acute, chronic or intractable pain.
The only perceived “crime” that these patients have committed is the misfortune of having a diagnosis that requires opioids to manage their pain.
The only perceived “crime” that most physicians have committed is committing their lives to treat their patients with autonomy and compassionately relieve their pain.
The pain community is being gas-lighted and scape-goated for a failed drug war. Our community is being blamed for the rise of unintentional overdoses that are fueled by lethally potent, illicit Fentanyl manufactured in other countries, delivered courtesy of FedEx.
Patients are suffering consequences for an “opioid crisis” or “drug war” that many legitimate patients and their healthcare providers have had absolutely no control over, and have never contributed to.
As a result of opioid hysteria, a term coined largely by intractable pain patients in response to being scapegoated, patients are being blamed for the influx of illicit opiates like Fentanyl from other countries including Mexico, Afghanistan and China.
This stance against patients is preferable to the Drug Enforcement Agency and other over-sight agencies than admitting that the “war on drugs” is an “epic fail!”
The facts supporting our position are beginning to pour in and mainstream media is slowly bringing transparency to the this issue.
However, untold damage has already been incurred by the pain community that can’t be reversed. There are a lot of special interests invested heavily in perpetuating “opioid hysteria” as it serves their bottom lines very nicely.
So, the pain community continues to be thrown under the “opioid bus” rather than re-group or change policy to protect patients or offer safe harbor to physicians who practice in good faith.
We can only go forward by rescinding the 2016 CDC Opioid Prescribing Guidelines as a failed public health policy, and in light of new information, it will be the pain community’s responsibility to inform the public of the truth.
The US National Pain Strategy, as supported by the Health and Human Service’s Opioid Task Force Prescribing Recommendations, as well as the American Medical Association have thus far, failed to protect patients in acute, chronic and intractable pain, along with non-profit organizations who claim they represent the “voice of the pain community” and instead lobby for special interests, further diluting the pain community’s platform, by conflating addiction with the treatment of pain.
National US Pain Strategy
HHS Pain Management Best Practices Inter-Agency Task Force Report
AMA National Roadmap on State-Level Efforts to End the Nation’s Drug Overdose Epidemic Leading-Edge Practices and Next Steps to Remove Barriers to Evidence-Based Patient Care
We intend to raise public awareness about the facts by raising our voices!
As a community, our mission is to make sure this undue harassment never happens to legitimate pain patients again.
So, how will we overcome obstacles to eAdvocate for our community?
Check out future PAC posts discussing overcoming obstacles to amplify our message!
Thanks for leaving us your thoughts and comments about the prevalence of pain in the US, how changes in public health policy have impacted your life, and how you are bringing transparency to the obstacles to accessing medical care that face the pain community.