Prescription for pain care: More physicians, more treatment

With risks from overprescribing and underprescribing, keys to easing primary care doctors' concerns are better regulations and more education.

By Andis Robeznieks, AMNews staff. Dec. 13, 2004.

The nearly 75 million Americans who experience chronic pain need help from primary care physicians.

There are about 10,000 physicians who specialize in treating pain, but that's not nearly enough, said one of the nation's leading pain experts, Russell K. Portenoy, MD. Only 5% of patients with the most severe pain ever get to see one of these specialists.

"You have a situation where the math doesn't work," said Dr. Portenoy, chair of the Dept. of Pain Medicine and Palliative Care at New York City's Beth Israel Medical Center.

Internist Scott M. Fishman, MD, president-elect of the American Academy of Pain Medicine, agreed.

"The bottom line is that, even in communities that have a lot of specialists, there aren't enough," said the chief of the University of California, Davis, School of Medicine's Division of Pain Medicine. "Pain is the most common reason people see a physician, so we all need to take it on."

There are, however, many obstacles to getting primary care physicians more comfortable in treating pain. Many physicians fear law enforcement action over perceived overprescribing and are concerned that underprescribing could result in civil litigation. Some of them feel the safest thing to do is to refer patients who need continuing pain treatment to someone else. To solve the problem, experts are calling for more pain education for physicians, regulators and law enforcement officials; revision of state policies that impede treatment; and general changes in approaching pain treatment.