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Pain Is Most Common Reason for Doctor Visits; Yet, Few Doctors Have Adequate Training to Effectively Treat Chronic Pain

Pain is the most common reason people go to their physicians. Ironically, few physicians have received adequate training to help patients who suffer from chronic pain, according to an article published in the Journal of American Osteopathic Association.

An estimated 100 million people in the United States are living with chronic pain. A 2011 study found that for every medical specialist, there are more than 28,500 patients with chronic pain, according to an August 12, 2013 press release by Henry Ford Health System.

As a result, primary care doctors are typically the ones charged with managing patients’ pain; yet, many lack the skills to effectively treat pain. A recent study of 117 U.S. and Canadian medical schools found that only four U.S. medical schools offered a required course on pain management, according to the release.

This is a major health care problem, according to study author and an internal medicine physician at Henry Ford, Dr. Raymond Hobbs.

Chronic pain is pain that persists for longer than three to six months—beyond what is considered normal healing time for an injury. Because an injury does not always correlate with the severity of a patient’s pain, physicians often become frustrated trying to objectively pinpoint the patient’s discomfort, Hobbs says.

“For most patients, the duration of pain is short,” Dr. Hobbs says. “Unfortunately, for some patients the pain never goes away. It is these situations that present physicians with their greatest challenge since few are formally trained in effectively managing pain.”

To understand the patient’s discomfort the physician needs to look not only at the pain, but also how it affects the patient’s life in terms of their psychological, social and cultural contexts, Dr. Hobbs says.

“Negative emotions can increase the perception of chronic pain, whereas a positive emotional state can lead to a better response,” Dr. Hobbs says, referencing a study of patients with chronic, disabling occupational spinal disorders that found 65 percent of patients had at least one psychiatric disorder and 56 percent had a major depressive disorder.

While prescription medications can help, Hobbs says one cannot ignore the risk of unintentional overdose. Research from 1999-2008 shows opioid medications causes more overdose deaths than heroin and cocaine combined.

Hobbs says a special set of questions called the Opioid Risk Tool can assess the risk behaviors of patients, and categorize them as low, moderate or high risk.

Hobbs offers these recommendations for physicians to help their patients with chronic pain:

• Work in collaboration with a team of specialists comprising primary care, physical medicine or occupational medicine, pain management and mental health.

• Patients being considered for oral opioid therapy like morphine, codeine and fentanyl should be screened for substance abuse using a five-point risk assessment tool.

• Set a threshold dose of 200 mg/d or less of oral morphine equivalents per day.

• Follow the so-called Universal Precaution model that calls for a complete medical evaluation and regular assessments of the four A’s of pain medicine analgesia, activity, adverse effects and aberrant behavior.

“Physicians have a moral responsibility to help their patients,” Hobbs says. “We also should realize the opportunity we have and to use it to decrease our patients’ suffering and to help restore their quality of life.”

Physical therapists are trained to help patients recover mobility, independence and quality of life after painful injuries, surgery and more. For more information about what physical therapy can do to address acute and chronic pain, contact A Physical Therapist, Inc.

A Physical Therapist, Inc., is a one-on-one physical therapy clinic in Delray Beach, Fla., and Harrisburg, Penn. For patients in Palm Beach County, A Physical Therapist, Inc., is easily accessible from Boca Raton or Boynton Beach. For patients in Dauphin County, A Physical Therapist, Inc., is easily accessible from Hershey and Marysville.

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