Healthcare System Failings

A complaint may be quite justifiable, but it remains only a way to vent frustration if not followed by an action plan to resolve the problem that led to the complaint in the first place. We frequently join together in parties of two or three or more and complain about any number of things. Seldom, though, do we join together around an action plan.

At the Institute for Chronic Pain, we aim to bring together scholars, clinicians, third party payers, patients, and the rest of the lay public around a common complaint. The complaint is the problem of chronic pain and how poorly it is treated. It involves a number of issues:

• A long-standing and still commonly held view, even among some providers, that chronic pain is the result of a long-lasting acute injury, usually conceived as an orthopedic condition
• A lack of understanding of the role of central sensitization in chronic pain
• Healthcare provider recommendations that commonly do not follow established clinical guidelines
• A resulting odd state of affairs within the healthcare system that the typical chronic pain patient obtains the least effective treatments first and obtains the most effective care last
• Third-party reimbursement policies that make the least effective treatments the most profitable to provide and the most effective treatments the least profitable to provide (which may in part lead to the odd state of affairs that patients typically obtain the least effective treatments first)

For these reasons, chronic pain remains a poorly treated condition. A number of studies show that the use of spinal surgeries, interventional procedures, and opioid medications have steadily increased over the last decade to an all-time high. Despite patients obtaining these unprecedented numbers of procedures and medications, applications for chronic pain related disability have steadily increased in a corresponding manner over the same decade.¹ Obviously, these treatments are not working. Chronic pain remains a poorly treated condition.

The mission of the Institute for Chronic Pain both identifies the complaint and an action plan for resolving it. We aim to resolve the problem of poor treatment of chronic pain by grounding chronic pain management on the principles of empirical based healthcare. We aim to see a day when the field of chronic pain management routinely provides what science tells us is the most effective care. The method we use to obtain this goal is to educate the stakeholders in the field. The stakeholders in the field of chronic pain management are healthcare providers, patients, third-party payers, policy analysts, and the public who eventually pay, in part, for all of our healthcare services. By educating these stakeholders, we eventually lead to a greater demand for more effective chronic pain management.

In terms of supply-and-demand, other organizations aim to change the healthcare system by focusing on the supply side of the system. They focus on changing provider practice patterns, or the policies of third party payers, or government funding patterns. The Institute for Chronic Pain aims to change the demand side of the supply-and-demand equation. We aim to provide high quality health information to inform all stakeholders. We envision a day when everyone knows that chronic pain is a nervous system problem, not necessarily an orthopedic problem, and demand treatments that are appropriate for the nervous system problem that they have. When they do so, they will pursue and obtain the most effective treatments that we have for chronic pain.

At this time, the most effective treatment for chronic pain syndromes is chronic pain rehabilitation.^{2, 3} All the components of a chronic pain rehabilitation program focus on down-regulating the chronic reactivity of the nervous system that is maintaining pain on a chronic course. However, this treatment is typically the last treatment that chronic pain patients obtain. In part, this fact is due to the continuing widespread belief that chronic pain is the result of a long-lasting acute injury, usually conceived as an orthopedic injury. This conceptualization leads providers and patients to pursue spinal surgeries, interventional procedures, and opioid management, all of which are largely ineffective in reducing pain or increasing functioning.

By focusing on educating all stakeholders in chronic pain management, we change how the public conceives of chronic pain and how they want to treat it. Third-party payers will then follow suit. They will subsequently make it easier for patients to obtain effective treatments and limit reimbursement for ineffective treatments. Once third-party payers change their reimbursement patterns, healthcare providers will recommend ineffective treatments less often. In terms of supply-and-demand, we change the demand side, which then changes the supply side.

In so doing, we also ground the field of chronic pain management on the principles of empirical based healthcare. The field will begin to routinely recommend and provide treatments that science tells us are most effective. With the routine use of more effective treatment, chronic pain will no longer be such a poorly treated condition.

References

1. Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: Time to back off? Journal of the American Board of Family Medicine, 22, 1, 62-68.

2. Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

3. Turk, D. C. (2002). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. The Clinical Journal of Pain, 18, 355-365.

Date of publication: March 25, 2013

Date of last modification: March 25, 2013