The need for preventing chronic pain: the "big elephant in the room" of healthcare.

INTRODUCTION

Chronic pain conditions are the number one reason patients seek care, number one cause of disability and addiction, and number one driver of healthcare costs, costing more than cancer, heart disease, and diabetes.[1-2] It is the “big elephant in the room” of healthcare and costs the United States alone over $650 billion in healthcare and lost work.[1-2] This is equivalent to 25% of total healthcare costs and nearly 5% of the total gross national product of the United States. The personal impact in terms of suffering, loss of function, disability, depression, addiction, and other consequences is incalculable.[1-3] Chronic pain is the most common cause of disability and opioid dependency, leading to more deaths than motor vehicle accidents.[4,5] If we want to reform healthcare, we must focus on preventing chronic pain.

POOR LONG-TERM TREATMENT SUCCESS IS THE CULPRIT

Chronic pain in the back, neck, head, face, and other areas are caused by conditions such as myofascial pain, arthritis, fibromyalgia, migraine, disk disorders, neuropathic pain, and other peripheral and centrally generated pains. These conditions may begin with an injury or strain but can persist due to the presence of risk factors such as repetitive strain, depression, poor sleep, stress, maladaptive postures, depression, catastrophizing, and others that can delay recovery, increase peripheral and central sensitization, and ultimately cause the persistence of chronic pain.[6-12] The majority of those with pain of more than 1 month in duration still have pain years later despite the use of pharmaceuticals, devices, surgeries, and other innovative treatments for chronic pain.[1,6,7] While major efforts are underway to prevent most other major health conditions, preventing chronic pain remains an enigma, overlooked by the public, neglected by the healthcare system, and generally ignored by the scientific community.

IT'S TIME TO FOCUS ON PREVENTING CHRONIC PAIN

We spend billions of dollars on advances in pharmaceuticals, devices, surgeries, and other innovative treatments for chronic pain yet fail to deliver successful long-term relief of pain primarily due to the lack of engaging, empowering, and educating patients in self-management strategies to reduce these risk factors, enhance our protective factors, and prevent chronic pain. The Institute of Medicine (IOM) states that clinicians' primary role in caring for chronic pain requires guiding, coaching, and assisting patients with day-to-day self-management in addition to evidence-based medical treatments.[1] How ever, most health professionals lack the time and training to perform this role and find little support and reimbursement for doing so. As the IOM simply states, “We need a revolution in healthcare to replace our current passive model of doctor-centered care with patient-centered care.”[1] This model is called transformative care and is designed to integrate robust self-management training with the best and safest evidence-based pain treatments. Clinical trials have found that patients who are also engaged in self-care with the support of a health coach have significantly more successful outcomes than they do with passive biomedical treatments alone.[13-15] We need both to enhance success of preventing and alleviating chronic pain and reducing patients' dependency on the healthcare system.

TRANSFORMATIVE CARE

This care model brings together targeted evidence-based treatments with self-management training to reduce risk factors, enhance protective factors in the seven realms of a person's life including the body, lifestyle, spirit, mind, emotions, and social and physical environments. Transformative care integrates healthcare professionals, health coaches, and the social support network to work together to support the health of the patient. A shift in our understanding of the balance between health and illness is required to improve the potential for successful long-term care. Innovative concepts such as a human systems, neuroplasticity, positive psychology, cybernetics, chaos theory, and cognitive-behavioral change have practical implications.[16-19] New strategies to implement this care model including whole patient problem lists, identifying risk and protective factors, integrative team care, patient-centered care paradigms, and use of health information technology will facilitate this transition. Embracing patient-centered healthcare paradigms such as self-responsibility, education, personal motivation, social support, strong provider-patient relationships, and long-term change will shift the balance of care from one of a passive dependent patient to an empowered, engaged, and well-trained patient who will not only prevent his or her chronic pain and disability but also enhance health and wellness. Ultimately, this will improve the quality of care, pain, and functional outcomes and significantly reduce healthcare costs.

CAMPAIGN FOR PREVENTING CHRONIC PAIN

To facilitate this change in healthcare, several organizations have initiated the People's Campaign for Preventing Chronic Pain.[20] The goal of the campaign is to ultimately transform the healthcare system to help every person who has or will have a pain condition by accomplishing three objectives:

Expand research on the causes and mechanisms of chronic pain. The campaign will develop the Chronic Pain Research Network (CPR-Net). The goal of this practice-based research network is to develop and test new online patient training tools, better and safer pharmaceuticals, and innovative patient-centered treatment strategies to improve prevention and alleviation of chronic pain. The CPR-Net can include any health professional who cares for patients with pain and is willing to participate in clinical research and be linked to other health professionals, patients, and investigators through a sophisticated integrated health information network technology.

Expand education on preventing chronic pain. We need to train health professionals, health coaches, and patients on how to implement transformative care in both primary and specialty care. In this regard, a massive open online course entitled “Preventing Chronic Pain: A Human Systems Approach,” is offered by the University of Minnesota at www.Coursera.org.[21] This free course provides 20 hours of online educational modules that blend creative, experiential, and evidence-based teaching strategies to help participants understand chronic pain and how a human-systems approach and transformative care can be applied to improve self-management strategies. The first release of the course was successful with 23 650 registrants. Of the participants who completed the initial course evaluation, 93% believed the course made a difference in their lives, and 85% of healthcare providers believe that it made a difference in their care of patients. As one healthcare professional stated, “Absolutely fascinating and enlightening. This information should be part of every healthcare educational program!”

Finally, advocacy is needed to help the general public, health professionals, health plans, and businesses promote preventing chronic pain and understand how this will improve all aspects of our lives, including health and wellness, relationships, productivity of businesses, quality and satisfaction with healthcare, and lower healthcare costs. Three strategies include advocating for public policies and supportive home and work environments; ensuring that corporations, health plans, and governments promote chronic pain prevention; and enabling communities and individuals to focus efforts on these self-care educational programs.

By accomplishing these objectives, the Institute for Health Care Improvement's triple aim of improving the patient's experience of care, enhancing the health of the patient, and reducing the cost of healthcare will be achieved.[22] Furthermore, the big “elephant in the room” of healthcare will finally begin to be addressed and take us a long way on the path of reforming healthcare. Why not support this effort?