It might be easy to conclude that anyone who wants to reduce the role of the profit-motive in healthcare must be either an extremist or a fool. Upon reflection, however, it becomes clear that we are experiencing an era of overtreatment in healthcare (see, for example, Dr. H. Gilbert Welch’s piece here) and one area where it is particularly apparent is in the management of chronic pain. While there are likely many causes of overtreatment, one of them surely is the profit-motive that occurs within a fee-for-service model of reimbursement.
In the last post, we looked at the influence of money on your healthcare providers’ recommendations. We saw that in a fee-for-service model of healthcare, which is the predominant model in the U.S., individual providers, clinics and hospitals get paid based on the number of patients they see and the number of procedures and tests they perform. In other words, the more patients a provider, clinic, or hospital sees or the more procedures or tests they perform, the more they get paid. As such, a fee-for-service model of healthcare incentivizes productivity – providing more care leads to making more money.
One of the more common sentiments that patients express to me is that they have come to the conclusion that money influences healthcare recommendations. After reflecting on all the years of chronic pain and all the years of failed treatments, many of which were tried multiple times, they have concluded that the business side of healthcare played too much of a role in their own care. They are now disappointed, angry, and jaded about how much they trust healthcare providers.
The third of three reviews of research on spinal surgery for neck pain was recently published by a group of well-known pain experts (van Middelkoop, et al., 2012; van Middelkoop, et al., 2013; Verhagen, et al., 2013). The investigators undertook the reviews of the research on different aspects of neck surgery because the most recent previous studies, done as Cochrane reviews (Fouyas, et al., 2002; Nikolaidis, et al., 2008), were now outdated. So, they systematically reviewed the latest published research on different types of spinal surgery for neck pain to determine whether and how such surgeries are effective. What they found was that spinal surgery for neck pain is not any more effective than other, less invasive, therapies.
It’s not uncommon to exclaim, at the beginning of a pain flare, “I’m not going to be able to stand it!” Another might express, “Now, I’m not going to be able to do anything today!” Yet, another takes it as a given that the increased pain is an indicator that the underlying health problem is getting worse. From this assumption, it’s easy to start thinking about how the future holds nothing but increasing disability, wheelchairs, and suffering.
These sentiments are examples of catastrophizing.
“Why do you guys always want to know how much stress I have?” While the patient who asked this question the other day had fibromyalgia, she could have had chronic low back or neck pain, chronic daily headaches, complex regional pain syndrome, or any other chronic pain condition. She was expressing a sentiment that I often hear in one form or another.
The Institute for Chronic Pain website has a new article on the social stigma of chronic pain. It explains the nature of social stigma and challenges both providers and patients to take the difficult steps to overcome it.
If it challenges and inspires you, please share it with your network.
Click here to read it.
Author: Murray J. McAllister, PsyD
Date of last modification: 10-26-2013
Insomnia is common among people with chronic pain. It's also problematic. It typically makes your pain worse and saps your abilities to cope. Understanding and overcoming insomnia is therefore important to successfully self-manage chronic pain.
The Institute for Chronic Pain celebrates this month its one-year anniversary of going live with our website and blog. The Institute for Chronic Pain is an educational and public policy 'think tank' devoted to changing the culture of how chronic pain is managed. We imagine a day when the management of chronic pain is guided by the principles of empirical-based healthcare (i.e., pursuing only those treatments that research has shown to be effective). Our public face is our website and blog, where we provide academic-quality information that is accessible to patients, their families, as well as providers and third-party payers.
September is Pain Awareness Month! It is a special month for us at the Institute for Chronic Pain (ICP). The theme of the month is one of the central goals of our mission. Specifically, our mission is to change the culture of how chronic pain is treated by promoting the theory and practice of chronic pain rehabilitation.
There’s a divide between chronic pain experts and their patients that rarely gets crossed. The divide centers on the issue of fear-avoidance of pain.
At first thought, it might seem ridiculous to accept that your pain is chronic. When I bring it up with patients, many of them tell me, not without irritation in their voice, “I’ll never give up hope of finding someone who can fix me!” Indeed, it’s common to think that accepting the chronicity of your pain is the same thing as giving up hope that you’ll ever get better.