When faced with intense criticism for her agency’s approval of the powerful narcotic painkiller Zohydro, U.S. Food and Drug Administration Commissioner Margaret Hamburg turned to a sobering statistic:100 million Americans are suffering from severe chronic pain, she said.
The 100 million figure has become a central part of the debate over the use of narcotic painkillers.
That number — the equivalent of more than 40% of the U.S. adult population — is exaggerated and misleading, according to pain experts familiar with how it was derived.
An unfortunate side-effect of modern heath care is that it views all patients in terms of standard categories, even while scientists are learning of more and more individual differences. The makeup of our genetics, epi-genetics, and even gut-bacteria cause a wide variety of responses to both pain and its treatments.
It came out of a report ordered by Congress that was introduced by lawmakers who have received hundreds of thousands of dollars from drug manufacturers.
Legislation authorizing the report was rolled into the Patient Protection and Affordable Care Act — better known as the Obamacare reforms. It required the federal government to enter into an agreement with the Institute of Medicine “to increase the recognition of pain as a significant public health problem in the United States.”
The figure is problematic in part because it lumps together everyone who reports chronic pain, which is defined as lasting three to six months — from those with persistent but manageable back pain to those recovering from surgery or battling cancer. It includes those who may not even seek medical help or treat their condition with over-the-counter products as well as those who turn to prescription opioids.
The label of “chronic pain” is now applied to any and all pain lasting longer than about 3-6 months, no matter its etiology: diabetic sores that don’t heal, damaged nerves from surgery, spinal nerve impingement, bone deformation, CSF headaches, migraines, muscle ischemia, phantom limb pain, arthritis, and even the “aches and pains of old age”. Is it then any wonder that it’s so difficult to find consistent treatments, patient responses, and outcomes?
A vast chasm lies between “chronic low back pain” and the excruciating pain of CRPS, EDS, or CSF headaches, which are similar to cancer pain. These severe kinds of pain are a proper target for opiates, while low level consistent and irritating pains are not.
Many of us with serious chronic pain have also suffered the normal everyday pains and those from injuries and aging, yet these are not the pains for which we seek opiate treatment.
Modern healthcare is based on the premise that it’s possible to classify and standardize ailments and treatments.
“If we are concerned about the message we are sending, we shouldn’t exaggerate the message because the eyeballs start to roll,” said Basbaum, a professor of anatomy at the University of California, San Francisco. “The message will be more powerful if people can believe it.”
While the 100 million represents more than 40% of the adult population, Von Korff said only about 20% to 25% of adults are substantially impaired by chronic pain and a smaller number — about 10% to 15% — have substantial work disability because of chronic pain.
“You don’t want to over-medicalize something.”
Past Journal Sentinel/MedPage Today investigations found the nation’s dangerous boom in narcotic painkillers has been fueled in part by aggressive promotion by drug companies that funded nonprofit groups that advocated for greater use of opioids.
Who but the drug companies would be willing to fund any organization that doesn’t follow the current anti-opiate sentiment? Sadly, this seems to de-legitimize any information and opinions that aren’t in line with Drug War propaganda, and undermine the patient support provided by these organizations.
A year before the report was ordered, the Institute of Medicine had taken a strong stand in favor of disclosure of conflicts of interest in medicine.
However, in producing the report, the institute didn’t follow its own advice about disclosing conflicts.Catherine DeAngelis, an Institute of Medicine member and the former editor of the Journal of the American Medical Association, took it one step further saying the pain organization board members and officers should have excluded themselves from serving on the panel.
“It’s hard to rationalize why they would not simply disclose all the potential conflicts on that panel,” Carlat said.