As financial and societal impact of chronic pain continues to expand in scope, healthcare delivery systems are seeking more effective and proven ways to manage the problem as demand for specialized pain care grows. Cyndy Walsh, CEO of ProCare Systems, a medical management company that develops comprehensive pain management programs, says providers will be forced to pay more attention to patients' pain.
Q. What is the extent of pain treatment in healthcare? How does it match up as a clinical concern vs. acute care episodic care?
Primary care physicians today provide most pain care. Pain exists everywhere and is being treated in a number of fragmented ways. However, physicians and healthcare managers usually lack clear algorithms to guide decision making in pain management. To be effective, pain specialists have to work closely with primary care physicians about the steps that can be taken for patients at the acute care level before a condition reaches the chronic stage.
Disease management approaches are increasingly being used to address chronic pain. These approaches are based on the underlying concept that chronic pain, like other chronic conditions, cannot be cured. Rather, the goal is to manage pain symptoms, keep patients functional and avoid costly medical encounters that drive costs higher. Using established concepts in the treatment of other chronic diseases, pain management specialists are providing relief to patients, educating chronic pain populations and their families and serving as a resource to referring physicians and healthcare organizations.
Treating pain as a chronic disease requires an integrated multi-disciplinary approach that includes a combination of medical management, interventional therapies, physical therapy and other rehabilitation methods, elements of behavioral medicine and ongoing care over the course of the disease.
Q. Are healthcare organizations taking pain management more seriously today? Do they tend to treat chronic pain on an episodic basis or are they using more evidence-based strategies? What are the latest trends on the reimbursement front?
Healthcare organizations are generally taking chronic pain management approaches more seriously, but there is inconsistency in treatment, as some organizations are clearly more sophisticated than others. Because pain treatment is fragmented, standards that exist for other specialties haven't yet been established for pain management. Establishing best practices and effective treatment protocols for pain management will be critical to recognizing and widely adopting consistent treatment approaches.
Today's healthcare environment is largely fee-for-service, and pain management is no different. Insurance tends to reimburse after providers offer documentation for the care they provide. Outcome-based or pay-for-performance reimbursement structures are likely to play a key role in the future. Because chronic pain occurs within a variety of diagnoses, outcomes data in the area of chronic pain management will be critical to the wide adoption of comprehensive and chronic treatment approaches.
Q. Do patients have growing expectations that the healthcare system can and should do something to alleviate their suffering from pain?
Healthcare consumers today will not tolerate having their conditions ignored. There is also a large and growing elderly population that's developing pain problems as a result of the natural aging process. For them, the goal is to maintain their independence.
Q. What are other approaches to managing pain outside of specialized pain management? What are perceived benefits and liabilities of these options?
There is no single approach to chronic pain management. While doctors do what they can to relieve their patients' suffering, in many cases chronic pain defeats standard approaches to treatment. For example, a treatment that may work when pain arises out of a broken leg or a surgical procedure may be insufficient for dealing with chronic back pain or fibromyalgia.
Alternatives to interventional pain management tend to be under treatment and the use of pain medications, the latter of which raises a separate set of challenges. But the disease management model espouses that managing pain symptoms, keeping patients functional and avoiding costly medical flare-ups are the keys to long-term, cost-effective pain care.
Q. How will pain treatment be perceived in its importance compared with other types of care? What implications will this have for both insurers and providers?
Chronic pain has quickly become one of the country's biggest healthcare challenges. More than 20 percent of American adults and 40 percent of the elderly suffer from chronic pain. Forty percent of chronic pain patients say it has a major impact on their lives, and more than $100 billion is spent annually on pain care.
The personal costs of chronic pain are even greater. Patients whose lives are significantly disrupted by chronic pain engage in behaviors that are maladaptive. They experience more stress, spend more time resting and avoid activities that may trigger pain. The average chronic pain patient has suffered approximately seven years, undergone three major surgeries and incurred medical bills from $50,000 to $100,000.
Given the amount of resources currently being used by patients, the imperative to manage chronic pain more effectively is only going to increase. As specialized pain medicine continues its transition to the community-based setting, disease management approaches are seeing great success in the efficient and cost-effective delivery of care.