Millions of Americans living with chronic pain struggle because two important public health issues— chronic pain and opioid addiction—are misunderstood and have been conflated. Until these two health conditions are properly distinguished, studied and addressed, the problems associated with both will continue. Tension and misunderstanding surrounding chronic pain and opioid addiction characterize the state of pain in 2016.
The Pain Action Alliance to Implement a National Strategy (PAINS) and the Center for Practical Bioethics has released The State of Chronic Pain in 2016 that you can read and download here.
German philosopher Frederick Nietzsche said, “Out of chaos comes order.” Many accept the profundity of Nietzsche’s famous comment, among them some chronic pain advocates. In June 2011, the Institute of Medicine published Relieving Pain in America (RPA or Relieving Pain) and established as its highest priority development of a national population health plan to be completed by the end of 2012. Pain advocates believed that such a plan would bring much needed attention to chronic pain and, in addition, bring order, direction, and resources needed to address this critical public health issue. In March 2016, the Department of Health and Human Services (HHS) published the National Pain Strategy (NPS). The NPS advanced all the recommendations made by the IOM committee and the notion that underpinned Relieving Pain, i.e., a “cultural transformation in the way pain is perceived, judged and treated” is needed. Furthermore, the National Pain Strategy provided a plan to transition from a biomedical pain care model, i.e., one based on prescription medications, interventional procedures and surgeries, to a comprehensive bio-psychosocial chronic disease management model. Unfortunately, the report arrived amidst a firestorm around the new guideline for opioid prescribing published by the Centers for Disease Control (CDC) just days before.
Bob Twillman, PhD, Executive Director of the Academy of Integrative Pain Management, reported “Several federal employees involved in the National Pain Strategy effort have suggested that since HHS released both the CDC Guideline and the NPS in the same week, there was an unintended effect causing the NPS release to be overshadowed and not to be reported on extensively.”
Throughout 2016, the attention of the media, the public, healthcare providers, and policy makers was on the opioid epidemic—NOT chronic pain—and to the extent that chronic pain received attention, it was conflated with the opioid epidemic. Consequently, to date, the National Pain Strategy has received little attention.
“In the past few years, there has been an unprecedented growth in the number of proposed policies at the state level that affect pain management. This is in large part due to policymakers who have been scrambling to address challenges related to opioid misuse, abuse, and diversion as well as chronic pain,” said Amy Goldstein, Executive Director of the State Pain Policy Advocacy Network (SPPAN)
The tension between these two public health issues— chronic pain and addiction—characterizes the state of pain in 2016. In 2016, the estimated 33,000 unintended deaths in 2015 associated with opioids reported by the CDC eclipsed concerns about under treated chronic pain and publication of the National Pain Strategy. Unfortunately, many have pitted these two important public health issues against one another as problems competing for attention and resources, or, worse yet, they have been conflated into one concern with what the IOM committee labeled “the opioid conundrum” at the center. Beyond the opioid connection, there are multiple overlapping public health issues, including:
• Both chronic pain and opioid use disorders are diseases
• Both patient populations have been stereotyped, stigmatized and poorly served by the healthcare delivery system
• Both require more research, data collection and analysis
• Both call for a public health response
• Both advocacy groups are far more likely to achieve their articulated goals by collaborating on common concerns.
Furthermore, there are individuals who have a dual diagnosis of chronic pain and addiction, and although the size of this population overlap is not currently known, it does exist and needs to be determined and understood.