Why Pain Management is an Essential Service
Among the many new terms like “self-isolation” and “social distancing” that Americans have had to learn during the COVID-19 pandemic, is “essential services.” Essential services refers to those professions that are indispensable to maintaining the health and well-being of residents and communities. Obviously, this includes emergency room physicians, police officers and certain government officials.
Although physicians from every medical specialty should be considered essential personnel during the current health crisis, it may not be readily apparent why pain medicine specialists are included in this category. These experts in acute and chronic pain conditions play a vital role in treating the millions of Americans that have ongoing pain issues and would further burden an already overstretched health care system. They also provide valuable expertise for other physicians about pain conditions related to COVID-19.
What Is Pain Medicine?
It may seem absurd that pain—which is the most common reason for seeking out medical care throughout human history—has only received specialization in the past few decades. It wasn’t until 1990 that the American Board of Anesthesiology first considered pain medicine as a subspecialty, and only in 1992 did the board accredit a pain management education and training program.
Pain management specialists are proficient in many skills including
- Diagnosing pain conditions
- Evaluating pain symptoms
- Nerve damage and treatment
- Metabolic disorders related to pain
- Pain medication dispensing
- Surgical interventions
- Leading pain management teams
- Palliative care
- Cancer pain
Although pain physicians may operate as independent specialists, much of their time is spent consulting with primary care and other specialty physicians. They can provide valuable and unique insights into pain conditions that may lead to treatment breakthroughs that might be otherwise unattainable.
Pain as a Public Health Crisis
The Centers for Disease Control and Prevention reports that almost one in five American adults has chronic pain—pain that persists for three months or longer—and that 8 percent of U.S. adults suffer from high-impact chronic pain that interferes with daily activities. This suggests that a significant portion of the U.S. population is impaired in some way from pain which creates an enormous loss annually. The CDC estimates that chronic pain costs the United States almost $560 billion annually due to medical expenses, lost productivity and disability programs.
Although chronic pain is common to all social sub-groups, some populations are more vulnerable to it than others. The poor and less educated who have diminished access to health care are more likely to become disabled or suffer a loss of income.
Indeed, without medical care from pain specialists many millions of Americans would probably be incapable of gainful employment or work in a diminished capacity. Not only would the U.S. economy suffer as a whole without the medical intervention from pain medicine doctors, but many critical jobs that play a key role in maintaining society, including police, firemen, and paramedics, would be vacated by pain sufferers.
Furthermore, without the unique medical treatment that pain management specialists provide, many people with conditions like low back pain, migraines and neuropathy would be filling doctor’s offices or emergency rooms, taking resources that could be devoted to fighting the COVID-19 pandemic.
The Role of Pain Medicine in the COVID-19 Fight
Pain medicine physicians also play a key role in flattening the curve, i.e. limiting the patient surge due to COVID-19. Because chronic pain patients often have weakened immune systems, they require additional medical supervision. This heightened susceptibility to COVID-19 stems from overworked immune systems that are fighting inflammation and autoimmune conditions like rheumatoid arthritis, as well as immunosuppressing side effects from common pain treatments like steroids and opioids. Many chronic pain patients are also advanced in age and likely to have comorbidities like high blood pressure or diabetes which puts them at greater risk of severe symptoms if infected with COVID-19.
So pain medicine physicians play important roles in helping manage pain symptoms as well as minimizing their patients’ exposure to the coronavirus. This may include specific medical guidance about maintaining pain therapies while in self-isolation, but it may also include more generalized patient management that may cover when to schedule elective surgeries or how to continue physical therapy sessions.
Pain may seem like a secondary concern during this global public health crisis, but many pain patients are faced with both pain conditions and life-or-death health problems. For example, cancer patients must continue their treatment programs which may or may not include a pain mitigation component. Pain physicians must often make critical decisions about powerful opioid medications—that include dosages and refills—scheduling treatment sessions and avoiding unnecessary complications that could prompt a trip to an ER.
Pain specialists must collaborate closely with other treating clinicians to minimize health risks during this period of fragility in the health care system. They must coordinate with other providers to ensure that remote care via phone or video can be optimized without diverting significant resources from health care providers focused on treating COVID-19 patients.
Pain Physicians and Palliative Care
It is uncomfortable to consider that a significant number of COVID-19 patients that are admitted into health care facilities will not leave, but it is important to consider the conditions under which they will exist in their final days. Palliative or end-of-life care may not be a high priority consideration given that it is possible to recover from COVID-19, but perhaps it should be. There is no reason that infected patients with a poor prognosis for survival should suffer needlessly.
Normally, pain specialists do not play a large role in palliative care, but this is more of a fault in our current health care system that often dismisses pain symptoms in terminally ill patients than an admission that these patients do not need such care. During this period of public health urgency, it may be necessary to reexamine what role pain experts play in end-of-life care. While the public is extremely focused on health care providers, pain management physicians can expand their role and shine a spotlight on pain medicine.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees. The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship. Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information.