I just discovered yet another research story that found that multidisciplinary treatment is the best approach for treating chronic low back pain (CLBP). Unfortunately, many people that experience chronic pain conditions, including low back pain, often receive only medication management instead of integrated treatment. In one study I reviewed, published by von Korff and colleagues in the December 15, 2007 Issue of Spine Journal, it stated:

CLBP is not only a serious problem for our healthcare system, but it also has a significant socioeconomic effect. The major costs of CLBP are the consequence of loss of productivity, work absenteeism, and disablement.

In the United States alone over $100 Billion a year is spent on chronic pain management. In addition there are over 100 million people in this country that live—or have lived—with chronic pain. One major research study stated that over 90 percent of people receiving treatment for chronic pain receive opiates. At a conservative 10 percent estimate over 10 million people who are probably taking those opiates, are experiencing substance use disorders.

Why does our healthcare system push a medication only approach? I think cost containment is a motivating force as well lobbying and very effective marketing by the pharmaceutical companies. Unfortunately, this may work in the short term, but the long term consequences of under-treated or mistreated chronic pain is an extremely high cost to pay. If people receive adequate and immediate multidisciplinary treatment, their prognosis for a higher quality of life is improved and the cost savings much higher.

The outcome of poor treatment interventions with chronic pain was demonstrated to me over and over when I was working with the California Workers Compensation system. Many of the patients I worked with were routinely denied treatment protocols called for by qualified pain management specialists. Not only were things like physical therapy, hydrotherapy, acupuncture, chiropractic, pain-focused psychotherapy, etc. not allowed, but even medications were often denied, including antidepressants. Unfortunately, I had one patient attempt suicide when his medication was cut off and he went into a severe depression.

I often ask people at my trainings to become active and advocate for change in our healthcare system. Many people mistakenly believe that one person can’t make a difference. This just isn’t true. For example, in the 1970s and early 1980s people killed by drunk drivers continued to escalate despite everything law enforcement could do. Many political committees were formed with law enforcement, healthcare workers and addiction professionals. Still, they were not able to make a difference.

Where all these professionals failed one mother triumphed. Candy Lightner’s child was killed by a drunk driver and she got mad. From this tragedy she founded Mothers Against Drunk Drivers (MADD). That organization was eventually responsible for changing the laws in all 50 states and reducing drunk driving deaths. As John F. Kennedy once said in his address to the United Nations; “One person can make a difference, and everyone should try.”

I just ran across a report that Methadone related deaths went up 390% between 1999 and 2004 according to the National Drug Intelligence Center. They were also concerned that the trend is continuing. I have also seen a big increase in the use of Methadone for pain management and the problems some people have experienced. One of the reasons for this increase I believe is the relatively low cost of Methadone compared with a newer medication like OxyContin.

It got me thinking about all of the attention that is coming out regarding the “big” problem with prescription drug abuse and diversion in the United States; that pain patients are now being considered criminals. If you believe the DEA (Drug Enforcement Agency), pain doctors and pain patients are criminals in need of punishment. There are knee-jerk reactions such as some states allowing law enforcement agencies to review prescription drug information without a warrant. I don’t know about you, but I don’t mind if my doctors or pharmacists want to check my complete record of prescription drug use, but I don’t like the idea that law enforcement officers can go on a “fishing expedition” to look for incriminating evidence.

Some of the pain clinics I consult with have patients who have been on opiates for many years; thus building up a big tolerance. At first glance it looks like “wow this person is out of control.” But a closer looks reveals they need what they are taking to have ANY quality of life at all. Doctors and other trained medical professionals should be deciding what is appropriate pain management—not the police or DEA. I know that some doctors and patients need law enforcement intervention, but that should be done through due process and with appropriate warrants.