Why Is Pain Management Rare?

By Author: Thomas Strickland
Total Articles: 102
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Well, as a headline, this needs a little TLC. In Europe where they have socialized medicine and, if you follow Sarah Palin, that means death panels or, even, death camps, most of the major teaching hospitals have pain management departments. It's not a perfect situation because smaller hospitals and clinics have yet to accept the need, but the momentum is building. This June, the European Federation of the International Association for the Study of Pain launched another education program to improve general standards in treating chronic pain. Many doctors cling to the old ways and ignore the evidence-based practice standards. That means they give out painkillers like candy. That's just like what happens here.

The US healthcare industry is very different from Europe. Although there are European insurance companies that issue health plans for individuals and employers, the majority of people are treated in public hospitals, even when they carry insurance. Whereas we have a for-profit approach to healthcare which requires the majority of people to pay for their own treatment - insurance is a good idea but somewhere between ...
... 45 and 50 million people cannot afford it. They rely on emergency rooms when a crisis looms.

When the majority of hospitals and clinics are for-profit, everyone who works for them is part of the machine to deliver the care that gives the biggest returns. That means ignoring whatever the evidence may say is the best approach to treatment, and giving the treatment that generates the most profit. Since insurance companies often pay out whatever the hospitals and clinics bill, everyone benefits except for the policy holders. Their premium rates just keep going up to pay for all this care. So look inside a hospital or clinic and you will find little time allowed for individual discussions or therapy. One-to-one is bad economics. You will always find consultations are against the clock and the most usual outcome is a prescription for some drugs or your agreement to more tests or procedures. Almost everything else is based on groups where everyone can be treated the same.

Pain management shifts the focus from profit to the individual patient. It requires spending time to review the original diagnosis and treatment given, and then discussion on the best way forward. This uses a lot of staff time with only one billable patient so most hospitals and clinics refuse to offer the service unless you are wealthy enough to pay for it or have a top-range health plan. To change this approach is going to require a top-down reform. Just as the federal government is forcing more emphasis on preventative care (which also reduces the profitability of hospitals), it needs to get interested in promoting pain management. Until then, all you can expect if you complain of pain is Tramadol. If the pain does not disappear, you will be given Tramadol in higher dosages. If you still complain, you will be prescribed the opiates with all the risks of dependence. This is the most cost-effective use of hospital resources. It maximizes profit. The pharmaceutical industry profits. Every investor is happy. That just leaves you in pain.