with nearly one-quarter of us hurting regularly, it’s not as if pain is an unusual phenomenon. In fact, it could hardly be more common: Persistent pain affects more people than heart disease, cancer and diabetes combined. Not surprisingly, it’s also the number-one reason we see a doctor or head for the hospital. “We know that pain is the primary reason that people initiate treatment within the healthcare system,” says Aaron Gilson, Ph.D., director of the U.S. Program at the Pain and Policy Studies Group at the University of Wisconsin School of Medicine and Public Health, at Madison. But even when patients do see health professionals, needless suffering may continue. Like most big problems, this one doesn’t have a simple explanation either. “The reasons for undertreatment of chronic pain are multifactorial,” Gilson says sim- ply. There’s also more than one villain; doctors and other healthcare providers, patients and their fami- lies and insurance companies can all take on some of the blame. Read on for our in-depth look at why, too often, pain isn’t adequately treated in the U.S., and how you can combat each of these fi ve factors to ensure you get the relief you need and deserve.
REASON Doctors don’t know how to deal with 1
diffi cult-to-treat pain (and sometimes don’t take the time to do so).
“Doctors are so undertrained in treating chronic pain,” Fishman says, “that we just haven’t done as well in quality of life as we have in quantity of life.” Most medical students receive no more than a few hours of pain training during their studies. One sur- vey by Johns Hopkins researchers found that only three of 126 U.S. medical schools require courses in
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pain, while 33 schools have required classes that contain sessions—an average of just fi ve—dealing with the topic. So if you’re seeing a primary care physician (rather than a specialist), as most people dealing with chronic pain do, you should assume that she probably didn’t get a lot of schooling in what ails you. The upshot is that your doc, however well- intentioned, may not know how to help you if your pain persists. And she may also rely on a limited arsenal of pain medications when there are other drug and nondrug options that are worth trying. Fishman and others are pushing for better pain
education for health professionals during their train- ing, and also more continuing education, but many of the primary care doctors treating pain patients today simply aren’t armed with the latest information on how serious a problem untreated pain can be. “Pain management is too often underrepresented amongst medical priorities, and those who wish to prioritize it often have not received suffi cient educa- tion,” says Fishman. Over the past 20 years, what Rollin Gallagher calls an “explosion of knowledge in neuroscience” has dramatically changed what we know about pain. “It wasn’t too long ago that pain was considered just a symptom, and if it continued too long it was a psychological problem,” says Gal- lagher, M.D., the director of pain policy research and primary care at Penn Pain Medicine and clinical professor of psychiatry and anesthesiology at the University of Pennsylvania, in Philadelphia. In oth- er words, intractable pain was once thought to be all in your head. Now we understand that “chronic pain can be a real disease process in the central nervous system. Pain becomes a chronic disease in and of itself,” he adds. But if your doctor isn’t aware of the most current thinking about your condition, and