Disease Management Update
Volume V, No. 40
February 19, 2009
Dear Healthcare Intelligence
Chronic pain is a very taxing condition — both physically and fiscally. On average, chronic pain patients lose 4.6 hours of work per week, costing employers $61.2 billion annually. This week's Disease Management Update focuses on chronic pain — the number of occurrences, non-traditional treatments, pain level reduction and recommendations for med school curricula when teaching this complex topic.
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
- Chronic Low Back Pain on the Rise
- Disease Management Q&A: Acceptable Levels of Pain Reduction
- HealthSounds: Chronic Pain — Solving America's Growing Epidemic
- Non-Traditional Therapy is Effective as Pain Management
- Survey of the Month: Health & Wellness Incentives Utilization
- Fixing What Hurts: What's Working in Pain Management
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1. Chronic Low Back Pain on the Rise
The prevalence of chronic, impairing low back pain in the state of North Carolina increased from 3.9 percent in 1992 to 10.2 percent in 2006. Increases were seen in both men and women, and across all ages and racial and ethnic groups, according to a study from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina (UNC) at Chapel Hill. The study is thought to be the first in the United States to use similar methods and a consistent definition of chronic low back pain to examine trends in the condition’s prevalence over time. The new findings also provide a possible explanation for rising healthcare costs associated with back problems.
“Considering the social and economic costs of chronic low back pain, these findings are alarming,” said the study’s principal investigator Timothy S. Carey, M.D., director of the Sheps Center and professor in the departments of medicine and social medicine in the UNC School of Medicine. “Low back pain is the second most common cause of disability in the United States and a common reason for missing work.”
Researchers noted that more than 80 percent of Americans will experience an episode of low back pain at some time in their lives and that total costs of the condition are estimated at greater than $100 billion annually, with two-thirds of that due to decreased wages and productivity. Some researchers have concluded that increases in the use of healthcare services for low back pain are due to people with low back pain seeking more care nowadays than in the past.
Reasons for the increase in chronic low back pain are unclear, although possible causes include increasing rates of obesity, depression and awareness of the condition, the study said. The changing nature of the state’s workforce — with a decline in the percentage of manufacturing jobs and an increase in construction and service industry jobs over the time span concerned — may be another possible factor.
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Disease Management Q&A: Acceptable Levels of Pain Reduction
Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Marilee Donovan, Ph.D., R.N., regional pain management coordinator, Kaiser Permanente Northwest.
Question: What are acceptable levels of pain reduction?
Response:(Marilee Donovan) In the pain community, they talk about one to two points on a zero to 10 scale. For most patients, one to two points falls in the 30 to 50 percent range. We try to get patients to understand not to expect 100 percent — 30 to 50 percent is average. Over the years we have seen patients improve 100 percent. However, that’s probably less than 5 percent. Most patients get about two points.
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HealthSounds Podcast: Chronic Pain — Solving America's Growing Epidemic
Too often, pain management tends to focus on the conditions rather than the people experiencing the pain, says
Dr. Agostino Villani, internationally recognized expert on chronic pain, CEO of Triad Healthcare, Inc., and author of
"Pain is Not a Disease." According to Dr. Villani, this way of thinking depersonalizes the experience of pain and
treats it as a disease instead of the complex, personal event that it really is. In part 1 of this interview with Dr. Villani, he discusses his new book "Pain is Not a Disease," as well as pain management programs, pain level reductions and side effects of pain medications.
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Non-Traditional Therapy is Effective as Pain Management
Researchers at the University of Missouri (MU) discovered that 73 percent of patients receiving non-contact therapeutic touch (NCTT) experienced a significant reduction in pain, had fewer requests for medication and slept more comfortably following surgery. An intentionally directed process of energy modulation to promote healing, NCTT allows practitioners to channel life energy through their hands to patients in a four-phase process — centering, assessment, “unruffling” the field and intervention — that allows a restoration of balance that enables ailing individuals to heal themselves. However, acceptance of the ideas that the human body is an energy-producing organism and that energy can be directed to benefit health is critical said Guy McCormack, lead researcher for the study and chair of the Department of Occupational Therapy and Occupational Science in the MU School of Health Professions.
In order to discover the effectiveness of NCTT, McCormack studied 90 patients receiving occupational therapy post-surgery and divided them into an experimental group where NCTT was given, a placebo group where a metronome acted as the treatment, and a control group where the participants did not receive any form of rehabilitation. When describing NCTT, McCormack said the process involves physics and human energy fields.
“There seems to be some subliminal aspects we are not aware of that may have to do with the connectivity between people,” McCormack said. “People don’t question how you can text someone, transmit messages through computers or visual images through televisions; thus the belief system is very powerful. If people believe that NCTT is going to be beneficial and are knowledgeable of it, it will be beneficial.”
While the participants receiving NCTT had considerable reductions in pain, patients in the placebo and control groups experienced an increase in pain perception due to the mechanical intervention of the metronome and chance.
Although it is difficult to introduce this form of therapy into medical settings, more and more hospitals are using complementary therapies like NCTT because consumers are interested in abandoning pharmacological solutions for pain, and instead are interested in harnessing their own capacity to heal through an inexpensive and cost-effective process,” McCormack said.
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Survey of the Month: Health & Wellness Incentives Utilization
As more healthcare purchasers and payors use rewards and incentives to drive participation and engagement in health and wellness programs, the industry has noted recent dramatic shifts in incentives use, preferred reward types and the activities for which incentives are offered. Please share your organization's experiences with health incentives and rewards by completing HIN's Survey of the Month. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
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Fixing What Hurts: What's Working in Pain Management
Chronic pain can affect an individual’s life in more than one way. To relieve the physical and fiscal suffering associated with pain, many healthcare organizations have implemented pain management programs. To discover how these programs work and who is using them, HIN conducted a non-scientific e-survey in which 186 organizations, including hospitals, nursing homes and health plans, shared their experiences with pain management programs.
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