The impact of Persistent Pain on the Health Care System

Psychosocial issues such as insomnia, anxiety, depression, somatization, catastrophizing was associated with persistent pain post mastectomy. Persistent pain after mastectomy is a public health problem (Schreiber et al., 2013). It is imperative to treat persistent pain adequately. Patients with unrelieved pain perpetually bounce back to the health care system for pain relief. In this way, they consume more resources from the health care system (Phillips, 2009).

Persistent pain is believed to be due to lack of knowledge among the health care providers (Chow, Saunders, Burke, Belanger, & Chow, 2017; Lynch, 2011). Therefore, education is a priority. Importantly, the pain management be managed by inter-

disciplinary professionals. Also, the assessment of pain need to be through. In using opioids, one needed to be aware, understand, that some patients could abuse the privilege. Accordingly, compared to normal population who were on prescribed strong opioids (0.16%), the true addiction was only a small fraction of this percentage (Breivik et al., 2013). The inadequate education had caused patients unnecessary suffering. Due to lack of education, physicians were unable to make the right treatment of choice, which resulted in inadequate pain management. Probable reasons were: first, their fear of malpractice suit and second, fear of patients experiencing tolerance to opioid use and dependence. These excuses were not acceptable any longer (Furrow, 2001). Further persistent pain should be viewed as a public health rather than just medical priority (Goldberg & McGee, 2011).

Barriers to effective pain management can also derive from patients. Patients may have inadequate knowledge to manage their pain. Targeted education for pain management has been proven to alter patients’ attitude towards pain management. For example, a randomised control trial has shown that, after intervention, patients reported improved knowledge and reduced willingness to tolerate pain for fear of addiction, and a reduction in addiction to analgesia was reported (Yates et al., 2004). A review by Bennett, Bagnall, and Jose-Closs also revealed that education provided significant benefit to patients in their cancer pain management (Bennett, Bagnall, & José Closs, 2009).

The monetary impact of persistent pain, directly or indirectly, on the health care system cannot be underestimated. It is evident that persistent pain costs the health care system from a loss of productivity. A medical record review found that the cost of persistent pain derived substantially from outpatient services (Park et al., 2015). There are strong association between persistent pain and payment for disability (Blyth et al.,

indirectly on the health care system. Hence, Duenas et al. (2016) recommended that health care policy makers pay attention to persistent pain; the aim is to prevent and manage pain while preventing disability and reducing the economic burden.

In cancer survivors, pain treatments need to meet expectations. Opioids are still the main drugs prescribed. In view of the risks of overuse of opioids, balanced against the positive benefit to survivors, this creates a real challenge to the health care system and health care providers. The risk of potential abuse will always be there (Pergolizzi et al., 2016). Boscarino et al. (2010) found evidence that 36% of patients met criteria for a life-time opioid dependence, and 26% met criteria for current opioid dependence. These data are in contrast to contrast results by Breivik et al. (2013) who found a .03% to .08% risk of dependence (J. S. Lee et al., 2017).

Given the cost issue, there is only a modest difference between the cost of inadequate analgesic treatment and the cost of effective pharmacological treatment in relieving pain. It is important to integrate a psychological model of treatment. The goal of psychological treatment should be diverted away from focusing on reducing pain, but rather on improving strength, mobility, and tolerance of activity. The model demands a collaborative effort between patient, significant others, and health care providers (M. P. Jensen & Turk, 2014).

Katz et al. (2015) planned a design of a multi-disciplinary team approach – by physicians, nurses, psychologists, physiotherapists, and psychotherapists as a

preventative measure to prevent long term postoperative pain. This team approach was to commence from preoperative period, continue during hospitalisation, and follow through after discharge. The criteria for the programme were: those patients who use large doses of opioids, patients with disability due to persistent pain, and negative emotions such as depression, anxiety, and pain catastrophizing. These measures were

aimed at reducing hospital stays, reducing readmission, and reducing overall cost to the health care system.

Structured, comprehensive, and multidisciplinary approaches improve skills and help patients regain autonomy to deal with persistent pain throughout their life. This will relieve undue emotional stress, improve coping capacity, reduce pain-related disability, and consequently improve financial status (Roditi & Robinson, 2011). Integrated treatments such as massage, acupuncture, and mind and body techniques like meditation and hypnosis are evidence-based in relieving cancer pain. The efficacy of such treatments cannot be denied. Further, these techniques are inexpensive, safe, and have no side-effects. In view of the accumulating evidence, these techniques have proven to reduce cost. Therefore, adopting integrated treatment into conventional treatment is not a bad option after all (Cassileth & Keefe, 2010).

In summary, the emergence and existence of cancer itself is a public health problem (Sankaranarayanan et al., 2014). The most utilised resource is the outpatients’ visits. Among others, persistent pain utilised the outpatients’ resources of the health care system. Since cost appears to be the highest concern, research should aim at lowering costs while retaining the effective outcome of relieving persistent pain in patients (Park et al., 2015).

Further, obstacles to effective pain relief include a lack of education by health professionals, limited availability of analgesia provided by the government, fear of litigation suits by health professionals, and the inflated cost of pain management. All of these should not be the barrier for effective pain management. Failure to provide pain relief may be perceived as a violation of protecting humans from suffering, is inhumane, and degrading (Lohman, Schleifer, & Amon, 2010).