ISSUES
Our current approach to pain leaves too many people suffering.
Issues With Education
Many clinicians receive only about 9 hours on pain education.
Pain is a key feature of many common diseases and a top reason people seek care. But pain is poorly addressed in medical education.
(fyi, veterinarians get about 85 hours on pain.)
Issues With Investment
Spending on pain research is inadequate given how common and costly pain is.
Pain represents a fraction of our research spending, while failure to treat pain costs society $635 billion each year.
We need innovation: Existing treatments like opioids have been around for centuries and carry risks.
We are still making breakthroughs in understanding pain.
Research is important because there is still much we don’t understand about pain, including why it becomes chronic.
New research shows that entirely different cells are involved in pain processing in male and female animals. This may explain differences in how people experience pain.
Issues With Care
The best pain treatment often combines different types of therapies.
Americans spend $87.6 billion in a single year on low back and neck pain alone.
These may include medications, procedures, physical and psychological therapies, or treatments like massage. Unfortunately, this multimodal treatment is not widely available and is often poorly covered by insurance. Too many are left with ineffective care, yet spend billions trying to treat their pain.
These problems are worse for disadvantaged groups.
HEALTH EQUITY
Pain can affect anyone but some groups face higher barriers to care than others: pain is a racial equity issue, a woman’s rights issue, a disability rights issue, an older person’s and children’s rights issue, and a human rights issue.
OPIOIDS AND PAIN
The Pendulum Swing
Opioids have been used for more than a century to treat pain. But, because of their potential for misuse, using opioids to treat pain has also raised concerns. The pendulum of policy has overcorrected and needs recalibrating.
1990s
Doctors encouraged to aggressively treat pain. The risks of opioids are understated. The result: rapid rise in prescribing of opioids.
2000s
Growing awareness that liberal prescribing has contributed to addiction and rising overdose deaths. Public health agencies urge doctors to be more cautious when prescribing.
Today
Recommendations by public health agencies are implemented as strict laws and mandates, limiting access for those with legitimate need and cutting some—often abruptly—off necessary medications.
Even today, all medical guidelines still say that opioids play a role in treating serious pain.
THE PROBLEM WITH PAIN TODAY
Our current policy approach to addressing opioid addiction in 2.5 million Americans is hurting the 50 million in serious pain.
NPAC Founder Kate Nicholson was working as a civil rights attorney for the Justice Department when a surgical error left her unable to sit or stand, largely bedridden, and in severe pain for almost 20 years. Using opioids as an appropriate pain management tool, she continued to function as a high-level federal prosecutor.
HARM TO PATIENTS TODAY
Policies today are harming patients:
At least 40 states, 3 major retail pharmacies, and many major payers have laws or mandatory policies with rigid limits on opioid prescribing. Most are based on the CDC’s 2016 prescribing guideline. The CDC considers these policies a misuse of its guideline.
Too many patients today face harmful barriers: they cannot fill legitimate prescriptions, are abruptly taken off medication with devastating results, or cannot find a doctor willing to treat them.
DID YOU KNOW?
More than 50% of doctors won’t see a patient who manages pain using opioids; 81% are reluctant to.
Public health officials have warned against these harms, but patients continue to suffer.
LEARN MORE: RESOURCES >
MYTHS ABOUT PAIN AND OPIOIDS
Many people believe anyone who takes opioids becomes addicted and that most addiction begins with medication from a doctor.
Here’s what we actually know about pain, opioids, and addiction:
Less than 1-8% of people become addicted when taking opioids for pain. Individual risks vary and should be screened for by prescribers.
Most people who misuse opioids didn’t get them from a doctor, but borrowed, took or bought those prescribed to someone else.
All current government and medical guidelines provide a role for opioids in pain not managed by other means.
In most cases, opioids should not be a first line of therapy for chronic pain, but when prescribed appropriately, opioids are indispensable for some patients.
Opioid prescribing has dropped a lot in the US, but overdose deaths have climbed dramatically.
Most overdose deaths involve many substances, legal and illegal, used at the same time.
The rapid increase in deaths in recent years is driven by illicit fentanyl, heroin, and stimulants.
CHALLENGES WITH COVID-19
People with pain may be at higher risk for COVID-19.
Many of the diseases that cause pain and many pain treatments can leave patients immunocompromised.
Covid-19 has shined a bright light on health disparities, with disparate impact on people of color, people with disabilities, and older Americans.
These same groups are disproportionately affected by pain or more likely to have their pain dismissed by a doctor.