Many Americans suffer from chronic pain. A national panel of experts reports that this condition has been largely under-treated by the medical community and needs to be addressed as an urgent public health crisis.

Convened by the New York City-based Mayday Fund, a private philanthropic organization dedicated to alleviating the incidence, degree and consequences of human physical pain, the panel includes primary care doctors, neurologists, anesthesiologists, pediatricians, emergency physicians, nurses, psychologists, pharmacists and patient advocates. This group has produced a report stating that inadequate training of medical providers has resulted in an epidemic of patients with inadequately treated chronic pain, sometimes for a lifetime.

"The burden of chronic pain is larger than that of diabetes, heart disease and cancer combined, yet it has been left out of the national debate on health care reform, and is not a priority with the National Institutes of Health," says Anne Louise Oaklander, M.D., PhD, a panelist and associate professor of neurology at Harvard Medical School and assistant in pathology at Massachusetts General Hospital.

Chronic pain is associated with illnesses such as arthritis, back problems, headaches, and cancer.

"Cancer can cause chronic pain in various ways, even in the survivors. Patients who have undergone cancer surgery, chemotherapy or radiation can be left with nerve damage, which can lead to pain even when these treatments are successful. And since more and more people are surviving cancer, it is a major cause of chronic pain," Dr. Oaklander said.

Research indicates that unrelenting pain is the second leading cause of medically-related absenteeism at work, and costs $100 billion a year in lost productivity. Many patients surveyed by the panel consider their pain disabling, and chronic pain is linked to job loss, depression and even suicide. In fact, Dr. Oaklander said one of the greatest fears that many cancer patients face after their diagnosis is the specter of unrelieved pain.

According to Dr. Oaklander and the panelists, acute pain is well managed in this country, but chronic pain is not, especially among minorities, women, children and low-income persons. This happens, she said, because "people who have chronic pain and seek help have to rely on the judgment of the provider," who may not have enough training in pain management, or worse, believe their patient is drug-seeking or not credible.

This sentiment has been especially unfair to certain patients.

"The most difficult group to be in for chronic pain is to be a young, minority male," Dr. Oaklander said. "If you ask for pain relief, it generates concern that you may be seeking drugs."

Although some people are addicted to pain killers, she believes the likelihood of dependency has been exaggerated; "this fear of abuse limits options for the majority. Physicians are not adequately educated during medical training about the different medications that can be used for pain management. This has created a paradox, with some patients taking too much medication, but many more being deprived. In this country, under-treatment of chronic pain is a much bigger problem than over-treatment."

Women are another group whose symptoms are sometimes dismissed by providers, Oaklander said. "This does not come from biology, but from sociology," she said. She pointed out that women who experience heart attack symptoms are less likely to be treated as quickly and well as male cardiac patients. Chronic pain can also affect children, whose pain symptoms may not be easy to interpret. "Children are difficult to treat. No one wants to give them an overdose or make them drowsy and unable to concentrate in school, so out of well-intentioned concern for their safety, kids can be under-medicated."

The panel recommends better training in pain management for primary care providers, and is urging the Department of Health and Human Services to revamp compensation policies for providers so the latter can spend more time with patients and ensure comprehensive pain care. Currently, doctors receive incentives when they perform procedures such as nerve blocks to treat pain, although "there is little or no evidence these help most chronic pain situations," Dr. Oaklander said.

"Payments to doctors should not be higher for sticking needles into people," she said, and also hopes that more money will be directed toward rehabilitation and ongoing counseling and support for patients, because these services are poorly reimbursed at present.

"We have many effective pain medicines, but not enough doctors know how to prescribe them. We are not espousing any particular medication, or coming down on the side of more or less meds, we are coming down on the side of better training, which will lessen both the problems of over and under treatment."

For more information, visit www.MaydayPainReport.org

This article is part of a regular health education series provided by the Gloucester Health Department and Addison Gilbert Hospital.