Chronic Pain: Barriers to Effective Pain Management

Chronic pain affects the physical, mental, emotional, and spiritual aspects of a patient's life. Daily non-cancer pain in the elderly has been associated with impaired activities of daily living, change in mood, and decreased involvement in social activities. Chronic pain impairs function, can lead to depression, and can even result in suicidal behavior. Chronic pain due to arthritis affects approximately 20 million Americans. This represents almost 50% of all pain sufferers.

What are the barriers to effective pain management?

Barriers to effective pain management are imposed by the health care system, physicians, and by patients themselves.

Patient Barriers:

-Reluctance to report pain to physicians.

-Reluctance to take pain medication

-Lack of education regarding available pain therapies.

-Compromised cognitive function secondary to certain pain medications.

Physician Barriers :

-Inadequate training and knowledge concerning pain management.

-Improper assessment of pain.

-Concern about scrutiny from regulatory agencies.

-Fear of patient addiction.

-Concern regarding analgesic side effects.

-Concern regarding the development of tolerance to analgesics.

Health Care System Barriers :

-Pain management is given a low priority in the system.

-Treatment availability problems exist in the system.

-Treatment access problems exist in the system.

-Inadequate reimbursement for pain management remains a problem.

-The most appropriate treatment may not be reimbursed or it may be too costly for the patient.

Many arthritis sufferers continue to take anti-inflammatory medications that no longer control their symptoms. Physicians, fearful of regulatory investigation, avoid appropriate treatment while switching patients from on ineffective medication to another. Some patients are forced to consider joint replacements prematurely, due to unrelenting, under-treated pain.