Is the government’s National Pain Strategy doomed to fail?

Pain ManagementOver the past few months, the federal government has mobilized against what is being called “the opioid crisis“: a national epidemic of fatal overdoses that in 2014 claimed more than 14,000 lives, the most ever recorded. Since most of these opioids were originally prescribed by physicians to treat pain, the Centers for Disease Control and Prevention recently finalized a guideline containing recommendations for appropriate opioid prescribing.

Over the past few months, the federal government has mobilized against what is being called “the opioid crisis“: a national epidemic of fatal overdoses that in 2014 claimed more than 14,000 lives, the most ever recorded. Since most of these opioids were originally prescribed by physicians to treat pain, the Centers for Disease Control and Prevention recently finalized a guideline containing recommendations for appropriate opioid prescribing.

The Food and Drug Administration will require that all opioid-containing medications be labeled with a new boxed warning about “the serious risks of misuse, abuse, addiction, overdose and death” associated with these drugs. And the Office of the Assistant Secretary for Health has released a National Pain Strategy that is designed to complement restrictions on opioids by promoting and reducing access barriers to non-pharmacologic management options for patients with chronic pain.

What is notably missing from these efforts is an attempt to understand why more people are experiencing chronic pain in the first place. In a recent article published in the Harvard Business Review, public policy and business professors Eileen Chou, Bidhan Parmar, and Adam Galinsky reviewed studies that linked widening U.S. income inequality and unemployment to greater levels of physical pain and purchases of over-the-counter painkillers. They also demonstrated in a series of experiments on college students that the prospect of economic insecurity increased the perception of pain and reduced pain tolerance. Chou and colleagues wrote:

Why does economic insecurity hurt? The cause is likely rooted in human psychology. When people encounter economic insecurity, they typically feel a loss of control. A sense of control is one of the foundational elements of well-being. When people lose this sense of control, their body goes a bit haywire and responds to stimuli differently — displaying weakened resilience and a lower pain threshold.

They went on to suggest that public and private organizations could do much address the opioid crisis by restoring people’s sense of personal control through policy changes designed to promote economic security. Increasing wages and reducing layoffs are obvious (if not always possible) solutions, but so are rent controls, education and childcare subsidies, and free-market policies aimed at reducing the cost of living.

One of the questions on my practice’s intake questionnaire asks whether the patient is experiencing financial insecurity. It has always struck me as a little odd; compared to, say, the question that asks if they feel safe at home, there seemed to be little I could do in the clinic to lift the burden of someone’s student loans or persistent joblessness.

A similar argument has been made against proposals to present “community vital signs” data in electronic health records: How are individual physicians supposed to act on information about social determinants of health? On the other hand, I can tell you all about the connections I’ve seen between economic stress and physical symptoms such as headaches or backaches, and how knowing more about my patients’ day-to-day struggles to stay financially afloat has frequently averted our going down an unproductive path of invasive and/or expensive testing.

So it isn’t a stretch to suggest that well-intentioned government efforts to stem the tide of opioid overdoses may flounder without explicitly addressing the social determinants of pain.
The Food and Drug Administration will require that all opioid-containing medications be labeled with a new boxed warning about “the serious risks of misuse, abuse, addiction, overdose and death” associated with these drugs. And the Office of the Assistant Secretary for Health has released a National Pain Strategy that is designed to complement restrictions on opioids by promoting and reducing access barriers to non-pharmacologic management options for patients with chronic pain.

What is notably missing from these efforts is an attempt to understand why more people are experiencing chronic pain in the first place. In a recent article published in the Harvard Business Review, public policy and business professors Eileen Chou, Bidhan Parmar, and Adam Galinsky reviewed studies that linked widening U.S. income inequality and unemployment to greater levels of physical pain and purchases of over-the-counter painkillers. They also demonstrated in a series of experiments on college students that the prospect of economic insecurity increased the perception of pain and reduced pain tolerance. Chou and colleagues wrote:

Why does economic insecurity hurt? The cause is likely rooted in human psychology. When people encounter economic insecurity, they typically feel a loss of control. A sense of control is one of the foundational elements of well-being. When people lose this sense of control, their body goes a bit haywire and responds to stimuli differently — displaying weakened resilience and a lower pain threshold.

They went on to suggest that public and private organizations could do much address the opioid crisis by restoring people’s sense of personal control through policy changes designed to promote economic security. Increasing wages and reducing layoffs are obvious (if not always possible) solutions, but so are rent controls, education and childcare subsidies, and free-market policies aimed at reducing the cost of living.

MDs, Watch a Video on Migraine and The Science Behind It. www.scienceofmigraine.com
One of the questions on my practice’s intake questionnaire asks whether the patient is experiencing financial insecurity. It has always struck me as a little odd; compared to, say, the question that asks if they feel safe at home, there seemed to be little I could do in the clinic to lift the burden of someone’s student loans or persistent joblessness.

A similar argument has been made against proposals to present “community vital signs” data in electronic health records: How are individual physicians supposed to act on information about social determinants of health? On the other hand, I can tell you all about the connections I’ve seen between economic stress and physical symptoms such as headaches or backaches, and how knowing more about my patients’ day-to-day struggles to stay financially afloat has frequently averted our going down an unproductive path of invasive and/or expensive testing.

So it isn’t a stretch to suggest that well-intentioned government efforts to stem the tide of opioid overdoses may flounder without explicitly addressing the social determinants of pain.

Kenneth Lin, MD – KevinMD.com
April 21, 2016

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When a clinician is prescribing a controlled substance, readily available information about the drugs that a patient is receiving from other providers can be a critically important component of the decision-making process…Increasingly, these [PDMP] programs have evolved into a useful tool for the clinician who must incorporate careful risk management into the prescribing of opioid analgesics or any other controlled substance.

Increasingly, these programs have evolved into a useful tool for the clinician who must incorporate careful risk management into the prescribing of opioid analgesics or any other controlled substance Prescription Drug Monitoring Programs Serve a Vital Clinical Need.

Editorial  Pain Medicine, The American Academy of Pain Medicine; 2011;12:845

Whenever possible, orthopaedic surgeons should request and review old medical records and speak with the patient’s primary physician about past medication problems. Currently, states have Prescription Drug Monitoring Programs designed to assist law enforcement in the identification of doctor shoppers; these data are also accessible to physicians.

American Academy of Orthopaedic Surgeons, Now, March 2014
Rick Bunker

Rick Bunker

Rick Bunker is a co-founder, and the CEO of Prescription Advisory Systems and Technology (P.A.S.T.). In this role, he is responsible for capital formation and corporate development.
Rick Bunker
Prescription Advisory Systems & Technology

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