Assessment and Treatment of Chronic Pain

Practical PAIN MANAGEMENT, March 2006 ©2006 PPM Communications, Inc. Reprinted with permission. Pain is arguably the most common condition seen in primary care, and the most costly one as well. Although estimates vary, the National Center for Health Statistics concludes that fully 80% of all physician visits involve some complaint of pain. Another study found that 38% of patients presenting in primary care were reporting chronic pain, but the prevalence of acute pain was not assessed. A research study at a large HMO studied the costs of chronic pain and other common chronic conditions. Using the data from this study, the estimated cost of each chronic condition was calculated by multiplying the average cost per patient for each condition by the prevalence of the condition. A chronic pain category was formed by combining patients with complaints of back pain, neck pain, headaches or facial pain. Using this approach, the cost of treating chronic pain exceeded the costs of all other chronic conditions that were assessed, including heart disease, respiratory disease, or cancer (see Table 1). The costs of chronic pain to society is also large, as chronic pain has been identified in some studies as the leading cause of disability in working age individuals. However, unlike most medical diagnoses which can be diagnosed by objective medical findings, pain is a subjective experience. Despite the high costs noted in Table 1, pain can usually be treated easily and inexpensively. The problem is that the small percentage of patients who go on to develop chronic pain are extraordinarily expensive to treat. One study found that 10% of back pain cases with chronic pain accounted for around 79% of the costs, which would make this group of chronic patients 34 times more expensive to treat than the other patients. Similarly, another study found that 5% of chronic back pain cases accounted for about 85% of all medical costs for this condition, making this group of chronic patients 57 times more expensive to treat. One of the reasons that chronic pain is so expensive is that it is a classic example of a biopsychosocial disorder. Due to the complex nature of chronic pain, medical treatment alone may not be effective, and multidisciplinary treatment may be needed. The purpose of this article is to focus on the psychological and social dimensions of chronic pain and to offer suggestions as to how these two dimensions can be combined with the medical dimension to improve care. Assessment and Treatment of Chronic Pain