Chronic pain is often a complex condition in which biological, psychological and social issues intertwine to amplify suffering and disability. While private and government insurance programs usually pay for medications and injections that can relieve the symptom of pain, it is often impossible to get adequate coverage for clinician time to fully evaluate the complex causes of persistent pain. Further, it’s hard to get support to coordinate and pay for adequate counseling, physical therapy, complementary treatments and other approaches that may empower patients in long-term recovery. If we improve care of chronic pain, we will in turn need fewer prescriptions and see less diversion and abuse.
The rollout of the Affordable Care Act is a huge opportunity to both reduce prescription drug abuse and improve the care of pain. The ACA names essential benefits that must be included in new programs, such as state insurance exchanges and Medicaid expansions that will serve as models for all insurers. These include a requirement for treatment of mental health and substance-use disorders in parity with other medical conditions that can potentially expand access to care for millions who need it.
In addition there are provisions to improve management of chronic diseases through better support for care coordination and doctor-patient visits, and helping patients better manage their own health. These should be extended to the chronic conditions of pain and addiction. Such benefits will reduce long-term health care costs by reducing more expensive complications of poorly managed illness.
Importantly, the Affordable Care Act also creates an Interagency Pain Research Coordinating Committee intended to enhance pain research efforts and collaboration. Despite the fact that pain is the most common reason people consult doctors, research focused on pain currently makes up less than 1 percent of the research budget of the National Institutes of Health.
Reducing pain and reducing drug abuse are not, as commonly thought, at odds. Members of Congress can fight prescription drug abuse and pain together by ensuring that the powerful opportunities afforded by the ACA to advance pain research and improve care of persons with chronic pain and with addiction disorders are fully realized in its implementation.
Dr. Seddon R. Savage is director of the Dartmouth Center on Addiction, Recovery and Education, teaches at Dartmouth’s Geisel School of Medicine and is the immediate past president of the American Pain Society.