Ouch: Patients Suffering From Docs' Poor Pain Management
Cindy Steinberg will never forget the day in March 1995 when chronic pain entered her life.
An accident at work left her crushed under a large file cabinet, resulting in torn ligaments and nerve damage in her back.
"I went from doctor to doctor," Steinberg said. "I tried nerve blocks, various injections, physical therapy and acupuncture."
Still, she couldn't get relief from the terrible pain. After long days of work as a manager of educational media and technology development, she often went home crying.
"I was lying on the floor during meetings," said Steinberg, who lives in Lexington, Mass. "Finally, after about years years, I found an osteopath who told me I had to give up my career."
Steinberg is one of 40 million Americans suffering from chronic pain, and new research has found that the overwhelming majority of people like her are suffering from poor pain management . In fact, a series of new studies found that the medical community isn't doing enough to manage different types of pain, including chronic, post-surgical and cancer-related pain.
Each of the three studies, published in The Lancet medical journal, reviewed treatment options currently available for each kind of pain.
The authors of the study on post-surgical pain said that pain management is improving thanks to regional pain relief, such as epidural analgesias and peripheral nerve catheters. For reasons that are unclear, however, patients are still suffering.
"Despite the introduction of new standards, guidelines, and educational efforts, data from around the world suggest that postoperative pain continues to be managed inadequately," wrote Drs. Christopher Wu and Srinivasa Raja of the Johns Hopkins School of Medicine in Baltimore, the study's authors.
They believe there could be a number of reasons, including a lack of pain assessment after surgery and doctors who simply don't use every available method.
Dr. Patricia Baumann, assistant professor of anesthesiology at the Emory University School of Medicine, said epidurals and other types of regional anesthesia -- or anesthesia administered to a certain part of the body -- are very effective with many of the patients she sees, providing pain relief and preventing the need for opioids such as OxyContin.
"It blows my mind that it's not better utilized," she said. "Sometimes, patients are afraid of epidurals, or the surgeons can't stop long enough to have the epidural placed.
Chronic Pain Guidelines - News
Cindy Steinberg will never forget the day in March 1995 when chronic pain entered her life. An accident at work left her crushed under a large file cabinet, resulting in torn ligaments and nerve damage in her back.
To review the empirical evidence for common approaches to chronic pain, the researchers surveyed the literature for systematic reviews, meta-analyses, and guidelines on osteoarthritis, neuropathic pain, fibromyalgia, and low-back pain.
The findings also reveal that chronic pain after surgery is a bigger problem than previously recognised, affecting up to half of patients undergoing common operations. However, new pain medications and techniques under development could help improve
Astonishingly, little is known regarding the long-term efficacy of opioid therapy for chronic pain. Of the 25 recommendations included in the Opioid Treatment Guidelines of the American Pain Society and the American Academy of Pain Medicine,
I have chronic patients and all the insurance companies want to do is limit their visits to six and done. What do I do?" "Tim," I inquired, "Have you seen the new chronic pain guidelines put out by the CCGPP (Council on Chiropractic Guidelines and
Managing Chronic Pain, Revisited: - Workers Comp Insider
We posted earlier this week on draft guidelines for pain management issued by the Massachusetts Department of Industrial Accidents. While we found much to like in the draft, our colleague Peter Rousmaniere, proprietor of his own blog on immigration issues , finds that the guidelines leave much to be desired. He views them as somewhat of a mincing mini-step in an area where rather big strides are needed.
Here are his thoughts on ways to make pain guidelines more effective: Medical treatment guidelines are helpful where clinicians, payers and courts desire an authoritative third party to say if and when a treatment is appropriate. But the value of guidelines really strikes home not only in the details but in how they pick their topics. Only so much can be covered proficiently. Guidelines need to focus on pressing matters of protecting lives and husbanding scarce resources. Then even the non-clinician in workers comp can say, "I may not understand all the medical details, but I know that these guidelines speak to my top concerns, and I will respect them and promote them accordingly."
Perhaps because workers comp chronic pain treatment guidelines tend to avoid some of the most pressing issues for claims payers, they are not as useful as they could be. Perhaps also because claims payers feel free to ignore them, which they regularly do, we don't see a visible, sustained effort within the claims payer community to improve the management of chronic pain cases.
Something for the Pain One thing the guidelines have done laudably is to alert their readers to the very important patient safety issue when opioids are prescribed. This is very important: claims payers usually don't require periodic drug tests for injured workers who have been prescribed opiates and they rarely are trained to respond when a test shows that the patient's urine has no trace of the prescribed drug.
On balance, the Massachusetts guidelines, like other chronic pain guidelines used in the workers compensation community, are rather narrowly focused to the point where their usefulness is compromised. These various guidelines focus on non-surgical treatment of patients after among newly injured workers. Prediction and prevention are areas in which only a few occupational medicine doctors and nurses have achieved proficiency. Claims payers should focus on the need to identify chronic pain risk and encourage doctors to intervene as early as possible, when chronic pain risk, having been identified, can be addressed before the downward cycle begins. Unfortunately, you won't learn about these best practices in these or in other state-promulgated guidelines. (I have proposed that chronic pain predictive models, matured through the wisdom of many, be placed in the public domain and inserted in treatment guidelines.
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