I had yesterday a very interesting discussion about pain and pain treatment, why is it accepted to have a certain level of pain and what to do to improve untreated pain. In the United States, in 2011 the annual cost of untreated pain is reported to be between US$560–US$635 billion[1]. The discussions were about drugs, drug interactions, side effects, convenience, adherence, patient preferences and even about culture and religious beliefs.
However heated the debate was, there is something clear: the ways in which pain is measured is still somehow leading to confusion, maybe because it is not well established that pain should be treated as a Patient Reported Outcome.
Payers tend to see and use pain scales as an objective measure of pain, but fail to interpret that most of the component is subjective. There is extensive research showing the difference between both components and functional impairment (Objective Functional Impairment –OFI, Oswestry Disability Index –ODI,…) has been advocated as a more objective scale.
Whether the systematic incorporation of these measures to pain trials will lead to a better treatment of pain is unclear. However we should strive to reduce the level of inappropriate treatment, as it is certainly inacceptable that, as reported in a US survey, as much as 75% of the patients continued to have pain after surgery despite treatment[2].
[1] King NB, Fraser V PLoS Med. 2013;10(4): Epub 2013 Apr 2.Untreated pain, narcotics regulation, and global health ideologies..
[2] Warfield 1995. Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology. 83(5): 1090-1094