Reducing Overtreatment due to Profit Motive

Reducing Overtreatment & the Profit-Motive in Healthcare | Institute for Chronic Pain Blog

No one in this interaction [doctor and patient] seems to require a higher degree of justification, such as some degree of probability that a therapy will be effective. The possibility of effectiveness, rather than then probability of effectiveness, is good enough

This state of affairs leads to scenarios like those of patients I see everyday. Working in chronic pain rehabilitation, we tend to evaluate patients after they have exhausted countless pharmacological, interventional, and surgical options – no matter how remotely likely they were to have been effective.

His description of what pain patients go through in their journey to relieve their pain is chilling:

The typical patient we see:

  • is in their forties or fifties and has had chronic pain for more than five years.
  • They have been managed on opioids for most of these years. …by the time they get referred to us, our patients have trialed a number of opioids and have become tolerant to even very high doses.
  • They typically have been to two or more interventional pain clinics, where over the years they have had ten to twenty spinal injections and
  • have had three or four repeated radiofrequency neuroablations.
  • They commonly have had three or more spine surgeries.

I am not exaggerating

Overtreatment in chronic pain management is exceptionally common.

I suspect that some providers in chronic pain management won’t think it is problematic at all. Spine surgeons and interventional pain providers profit greatly from the current fee-for-service practice patterns

Instead of obtaining care that professional organizations agree is the most effective, patients continue to obtain MRI or CT scans, interventional procedures, and spine surgeries at increasingly high rates (Deyo & Mirza, 2006; Deyo, et al., 2009; Hrudey, 1991; Ivanova, et al., 2011; Mafi, et al., 2013; Pham, et al., 2009). Such less than optimal tests and procedures constitute some of the most over-utilized assessments and treatments in our healthcare system.

Take the time to teach patients about what therapies are most effective.

It takes time to teach patients why orthopedic treatments for chronic pain, such as spine surgeries and interventional procedures, are commonly ineffective. The prevailing zeitgeist remains that chronic pain is an orthopedic condition. Initially, it often doesn’t make sense to patients why rehabilitation therapies are more effective.

Support policies and organizations that encourage effective care over profitable care

Support organizations such as the following:

  • Institute for Chronic Pain
  • Body in Mind Foundation for Ethics in Pain Care
  • International Association for the Study of Pain

If you find important information, pass it on to all of those in your network. (Indeed, please pass this blog post on to all in your network.)

4 thoughts on “Reducing Overtreatment due to Profit Motive

  1. painkills2

    The Institute for Chronic Pain says:

    “All these data indicate that we should not assume long-term opioid management is an effective treatment for chronic pain.”

    Yeah, I don’t agree with that.


    1. Zyp Czyk Post author

      I also disagree with the sentiment of this statement, but I have to agree that opioid pain management isn’t very effective – it just happens to be the best solution we have right now (and has been for thousands of years)..

      I’m not sure the public understands that, even with strong pain meds, we still can’t be “normal” or do “normal things”. I certainly used to believe I’d be fine as long as I could take opioids to relive my pain, but over the years I was disabused of that notion. The pain kept increasing and eventually exceeded my ability to keep it at bay with opioids and the 3 other medications I take for pain and depression (which are so interrelated it’s hard to separate them).

      I’ll happily toss the opioids aside as soon as they develop a more effective method to treat my pain, but asking us to do without while we wait is just crazy. Imagine if the rest of the medical field handled illness this way: no treatment would be offered unless it was 100% effective. That’s just not possible.

      Liked by 1 person

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