Pertinent pain data

Here's a little gem I found while cleaning up my hard drive. It's from early last year...

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Each year, 80,000,000 (that's eighty million) Americans seek professional care for pain.

Combine the numbers of Americans who seek care for diabetes, heart disease, or cancer -- three much sexier issues -- and they still aren't as many as those who seek care for pain.

• Pain is the cause of 25% of all sick days.
• 50% of those with nonmalignant pain have considered suicide.  (That puts a real crimp in a family's earning power.)

The consequent costs of lost productivity and reduced contribution to the tax base & economic flow, the social impact with concomitant loss of productivity, etc., has never been quantified (that I know of), although it certainly exists. With that large a base, and that wide a ripple-effect, it has to run into billions of dollars per year.


Each year, we spend $100,000,000,000 (that's one hundred billion) on the direct costs of dealing -- badly, expensively, and inconclusively -- with pain.

That same amount could buy:

• More than one-fifth of Medicare’s entire 2010 budget.
• 60% of 2010 Federal spending on long-term unemployment (to which disability is the single biggest contributing factor, and pain is the single most common factor in disability.)
• 5 weeks of current military spending, with two wars to prosecute and unprecedented numbers of walking wounded to care for.

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I had forgotten those facts.  I was geekishly delighted to find them. But it is definitely an answer in search of a question, and in this case the question is this: why the hell are we wasting so much money, time, life and energy on handling pain so badly??

There are profound cultural and economic reasons why the present, appalling system is still in place.  I'm not rich enough to face those reasons down so I'll leave that as an exercise in logic for the reader: follow the money.  Who profits by this system?  Who funds it?  Who benefits, and of those who benefit, exactly how do they benefit? What do they give up or pay, in order to reap those benefits? What are the benefit/drawback profiles for the many different stakeholders in this system?

Pain patients are the least important stakeholders in this system, and that doesn't seem right to me. I realize I may be biased.

Sorting out the answers could keep you busy for awhile, but once you figure out a couple of common denominators, it starts to fall into place very easily. It's a bit disconcerting at first, though.

The point, as far as pain control is concerned, is this: we're studying the wrong things about it, and we're treating it the wrong way around.  There is no conclusive success path on the present trajectory, just increasingly expensive ways of mitigating these largely failed clinical (and economic) strategies.

And that's today's ray of sunshine! :)

References:
“Chronic Pain Fact Sheet”, http://www.cssa-inc.org/Articles/Chronic_Pain.htm (journalistic summary)
“AAPM Facts and Figures on Pain” , http://www.painmed.org/patient/facts.html (cited sources include the AMA, ADA, AHA, NIH)
THOMAS (Library of Congress online)
Office of ppp, http://www.whitehouse.gov/sites/default/files/omb/budget/fy2011

Himalayan dreams

Had a dream of a remarkable wolf. It said it was from an extinct ancestral species. There were great mountains around us. I got curious and looked a few things up.

Timing couldn't have been much better. In 2004, scientists examined mitochondrial DNA and cleared up a lot of questions about speciation and ancestry:

Here's the Smithsonian's article with that graphic: http://nationalzoo.si.edu/SCBI/SpotlightOnScience/fleischer2003108.cfm

Until this study, all canids except maned wolves (truly ancient) and coyotes were thought to be basically a type of grey wolf; Tibetan and Himalayan wolves were different flavors of the same breed. (The web being what it is, the old ideas of the much-loved grey wolf being the grand-daddy of them all still show up everywhere.)

Turns out the beautiful and sweet-faced Himalayan wolf is the ancestral canid from which Tibetan wolves, grey wolves, Mexican wolves, red wolves and modern dogs (from molossers to dachsunds) are all descended.

The adorable mutt I grew up with. The huge, terrifying sheepdogs of Turkey, where I was born. The overdressed show poodle that walks my marina. The chihuahua who helped fix my boat. All from the Himalayan wolf.

There are only 350 of this extraordinary species left, as of 2004.

http://news.bbc.co.uk/2/hi/south_asia/3804817.stm

The main problem? Human ignorance, voraciousness and violence.

Because 12 billion of us just isn't enough, humans are expanding cultivable and buildable land every day to feed still more. I'm not sure why this is still seen as a better option than parental education and birth control, which are tragically underfunded worldwide.

Wolves are hunted for sport, because some people just have to prove they're better than anything that doesn't have ballistics and steel.

Wolves are hunted out of fear, because they are the bugaboos of Himalayan legend -- since wolves have been made metaphors for the vilest traits of humanity in Europe and Asia alike. They aren't like that, we just wish they were, so we wouldn't realize we are looking in the mirror when we think of unrelenting evil.

They are hunted for killing livestock, which they do in the winter ... But the ranchers who keep a couple donkeys with their herds, never lose animals to wolves. Donkeys have no fear of wolves and will kick the living snot out of anything that attacks their herd. Many ranchers don't know this! Livestock predation is a stupid problem with an easy fix.

Rumor has it there's a captive breeding program in India, but I haven't been able to track it down online. I'd be happy to make a website for them with a big, persuasive "Donate" button.

Meanwhile, I'll keep looking.

Addendum 1

Turns out that donations aren't possible: http://wildlifesaviour.blogspot.com/2011/05/himalayan-wolf.html. HOW is that POSSIBLE? Further research needed, apparently.

Refocus on what works: In memoriam

Debbie died yesterday. She was a never-failing source of encouragement and intelligent support on one of my key online CRPS support groups.

She died on the table, while undergoing a medical procedure. I don't know exactly what it was, and given my respect for patient confidentiality, it's none of my business.

She's the first person to die of my disease, to whom I felt personally attached. Needless to say, it's sobering as hell.

I've written about the need to attribute deaths from this disease correctly. I'm preparing my own final papers. These thoughts are nothing new.

But today, they are biting deep.

I've recently become highly politicized over rights abuses and intolerable corporate stature in my country. I have privately -- and quietly -- become convinced that the US healthcare system is so completely predatory, so opposed to its own mandate, that it will never offer healing for anyone in my position.

Debbie's death has broken through my professional anxiety about appearing detached and scientifically sound. I have, at long last, become politicized about the most important subject in my life, after 25 years of personal and professional involvement up to my back teeth.

I have minimized my discussion here of what actually works. That dishonest omission has done us all a great disservice. I'm going to discuss what works, whether or not it's FDA approved, pharmaceutically profitable, or adequately studied.

Medical studies are a shining example of the fact that we inspect what we expect, not necessarily what we need. The fact that studies have not been done on most modalities, or not rigorously done in double-blind experiments, doesn't mean the modalities don't work.

It means the studies need to be done. Period.

Where I understand the mechanisms of action, I will explain them. Where studies don't exist, I'll detail what should probably be explored.

But I have had enough of silence. I will not die as Debbie did. I will not die on the table. I certainly will not die saturated with soul-destroying pharmaceutical-grade poisons, as so many of us do.

I will find a better way. I will find a way that works. I'll do my best to persuade others to study the modalities involved, and to fund the studies. My legislators will learn to recognize my name on sight, because their slavish debt to the pharmaceutical industry is absolutely intolerable and it's up to me, and others like me, to convince them of that.

I wish Debbie a painless and peaceful rest. I hope her extraordinary husband finds enough strength and comfort to manage life without her.

For myself, I want the intelligence, resources and strength to find a solid cure, make it happen, and spread the word.

No more silence. It's too much like consent or, worse, collusion.

I do not consent to the deaths of my friends.

With my eyes now open, I'll no longer collude.

Let's find a real way out.