Uninsured patients are old news. The number of uninsured ebb and flow with unemployment rates, the economy and government whim interventions and cuts.
It's bad enough to be uninsured, but imagine having a chronic condition and being uninsured. Then imagine having a disease or condition that is universally scorned, discounted or dismissed and be uninsured.
Imagine being in excruciating pain every day and being uninsured and then having everyone you know tell you that you just have to grin and bear it or that, because you do take pain meds, you're a wimp.
Imagine you were in a horrific accident and your leg was nearly torn away and it was reattached but there was some nerve damage. Nerve damage that sends a teeth jarring zing up your leg every time you move it and your doctor tells you that you just have to live with it.
Some people don't have to imagine it, they're living it.
It comes down to perception vs. reality. Is this a patient in pain or are they an addict? Are they selling their prescriptions? Uninsured? hmmmm...
We have to separate the drug trafficer from the patient in pain. Pain management doctors don't want the trafficing and have methods to reduce it (verified MRI's, various (covert) exam techniques, drug tests, aberrancy surveys), but trafficers slip through. One problem is that there's no reliable medical test that confirms patient pain levels and what is tolerable for one person is unbearable for another.
Why defend the uninsured pain management patient? This patient is universally scorned, derided and dismissed as weak, a faker or a drug dealer. Physicians and nurses refuse to give the meds in the doses needed to alleviate pain. If there is anywhere, the pharmaceutical complex has failed us, it's in pain management. We don't have effective non-opioid pain relieving medications that works for serious, debilitating pain. Tens units are of limited use. Botox injections to kill the nerves near pain sites is risky and untested. The list goes on.
The fact remains that the most effective pain relievers are addictive opioids, which puts law enforcement in the examining room with the patient and the doctor. These drugs have strong side effects of addiction, nausea, dizziness, mental sluggishness, gastric upset, constipation and nightmares. Narcotics are strong drugs that can kill people if they are misused, so law enforcement has an interest in how they are distributed.
Doctors and nurses fear the loss of their medical license and routinely deny pain relief. Doctors have biases concerning pain and some are more empathetic than others. Many encourage people to train themselves to ignore pain. Doctors and nurses are trained to lie about pain so they can under treat it. They are taught to describe painful conditions and procedures as "uncomfortable" or a "little pinch" which is often a damn lie. Some physicians and nurse practitioners simply refuse to order anything stronger than Motrin. Others fail to tell patients that they can get permanent liver damage by overdosing Tylenol. Many doctors assume the uninsured patient seeking pain relief is a drug addict or trafficer until they prove their innocence. The doctor could be right or wrong, but they won't lose their medical license for under prescribing.
Pain and uninsured (or underinsured) is double trouble. Being in pain and uninsured is considered a risk factor for misusing pain medications. The uninsured patient is encouraged to get the treatment and skimp on the pain meds, which is exactly the opposite of what the patient wants to do.
A person without health insurance has a different type of double trouble when a painful condition strikes. Treatment is expensive. Most people cannot afford medications let alone the potential benefits of physical therapy, bracing, massage, acupuncture, surgery or anything in between. Effectively treating pain can drain a person financially, especially if the pain prevents someone from working. Without a means to pay for proper treatment, the pain can be left unchecked and the bills can pile up quickly. Chronic pain is enough trouble without financial ruin to double the trouble.
There's a group of uninsured who work. They work to pay their way and to pay for their medical care. They don't get much respect.
Pain Statistics
According to the CDC's 2006 Chart Book (pgs 68-81), 26% of adult Americans (60 million) experienced pain lasting more than 24 hours and 14% of adult Americans (33.4 million) are in chronic pain for 3 months to 1 yr or longer. We also can see a big increase in people on narcotic pain relievers as were in 1994. The CDC proves what the DEA denies. The DEA doesn't believe in pain. The DEA has browbeat most surgeons, cardiologists and primary care physicians from adequately treating chronic conditions with symptomatic pain.
Here's a profile of those of us in pain:
and
The first chart shows that 26% (60 million) of us have pain lasting more than 24 hours at least once in a year. The second one shows that 14% of those who had pain for more than 24 hours, were in chronic pain for 3 months to 1 year or longer (33.4 million). Yes, that means 14% or 33.4 million of the U.S. adult population has chronic pain that lasts 3 months to 1 year or longer.
This next chart shows the number of people who used narcotics in the month before their interview. It shows that 5.3% of adult women and 3% of adult men (over 9.7 million people) took narcotics in the month prior to taking the survey.
To line these stats up takes some thought. We have 60 million people experiencing pain of any sort that lasted for longer than 24 hours and 33.4 million of these people have chronic pain lasting for 3 months to 1 year or longer; but only 9.7 million (1/3rd of those experiencing chronic pain, but only on 6th of the 60 million or 4.2% of the adult population or 3% of the U.S. total population) take narcotics for this pain. What this survey didn't tell you was how long a course of treatment of narcotics they took or the intensity of the pain. Was it for 2-3 days like you would take after minor surgery, 10 days for more major surgery or was it every day like you would for a knee that has no cartilage (so to speak)?
The Patient Perspective
Some patients believe they should deny their pain despite evidence to the contrary. I met a patient last week who was a former Navy Seal. He told me that he used to think pain was for wussies. Pain was easily ignored. He did that until he had a misstep down a loading dock with 60 pounds on his shoulder. He had 6 months of unimaginable pain. He kept thinking "Pain's for wussies", "Pain's for wussies" and "I can't afford the insurance hike." "I can't afford the insurance hike." (Both were ineffective mantras.) He didn't get treated for 6 months and has permanent damage because he didn't "believe in pain" and feared what the cost of treatment would do to his insurance premium.
Sometimes the untreated pain patient goes off the deep end. If you read the story in the link, you can see the scorn dripping off the keystrokes from the reporter. It's tempting to laugh at her. How much pain could drive you to that extreme? If you think nothing could make you shoot yourself, then chances are you don't know the level of pain that drove her to that irrationality.
Horrendous short term pain (less than a day, no more than 10 days) would be passing a kidney stone, gallbladder attacks (before diagnosis and surgery), acute bursitis or preparation for a dental crown. Longer term pain (more than 10 days) is a herniated disk, degenerative disk/joint disease, some types of heart disease, a reattached limb or cancer. Untreated pain leads to other complications and pain is often seen with depression (which one causes the other is a focus of studies).
Law enforcement has a concern (legitimate or not) and the medical community must deal with the concern or be hounded into denying the patient pain relief. Confirming the patient is taking all their pain meds is a problem. Using a quantitative saliva drug tests or urine quantitative drug tests (showing how much drug is in the system) instead of the qualitative urine testing done now (shows only presence or absence of a drug) is expensive and only shows use over the last 24 hours. Hair shows presence or absence from the last 90 days. The best monitoring methods haven't been adequately studied yet.
Current attitudes from the average non-pain experiencing person in the street is that prescription drug abuse is off the charts and needs to be curtailed. That perception is promoted by law officers who don't have a right to practice medicine. That perception is incorrect. That perception is unlikely to be championed by health care advocates, because the victims are perceived to be losers.
The result is we have a societal perception that people in pain are wimps or fakers who want to peddle drugs and we have the DEA with a "Pain is for Wussies" mentality practicing medicine with out a license.
The real solution is to appropriately treat pain and measure drug levels instead of drug presence. Denying a patient pain relief is wrong.