As a family physician for more than 40 years, I have seen countless patients struggling to alleviate chronic pain, with far too many turning to self-destructive coping methods such as alcohol and opioids. Unfortunately, the struggle with chronic pain isn’t going away – and more alarming is the fact that those suffering from it are getting younger and younger. The latest data on chronic pain show patients between age 18 and 34 are reporting the most chronic pain, and they are desperately seeking relief. It’s our job as physicians to help them. Right now, we may be failing.
Nearly two-thirds of young adults report that they suffer chronic pain, with most of them saying they are in pain every day. Among those in pain, 75% are not even sure what kind of health care provider might be able to help them, and 22% say they’ve chosen to use cannabis and/or CBD oil to self-medicate. These are among the surprising findings of an online Harris Poll of 2,063 adults that Samueli Foundation supported in September to learn more about the current state of chronic pain during the pandemic.
While it’s startling that younger people are experiencing more chronic pain, it does correlate with what we already know about these patients – that they’re sicker than their parents were at their age. One study recently showed that young adults have poorer physical health, and they have higher levels of maladaptive behaviors, like smoking and drinking alcohol.
In addition, depression is one of the leading causes of illness and disability among adolescents. These so-called “diseases of despair” have only worsened since the COVID-19 pandemic. Younger adults face increased stress and anxiety levels without their normal ability to work and connect with people. Even before the COVID-19 pandemic, 60,000 Americans were dying every year from opioid misuse; the death toll topped 93,000 in 2020 and will be more than 100,000 this year – the highest number of opioid deaths ever recorded. Of course, those are just the ones accounted for.
These survey findings should be seen as a call for help. Increasing numbers of people overall realize the need to take better care of themselves. They are also seeking their doctor’s help more often than they did pre-COVID, desperately looking for guidance for their chronic pain. Among all adults, nearly 70% said they wanted more information, and 79% said they wished their providers took pain more seriously.
These findings feed into what so many of us already know: Chronic pain is not just a body thing; it’s a mind-body thing. The body’s inflammatory response does an amazing job in fighting off acute pain and returning us to normal when the injury causing the pain is gone. But psychosocial stressors severely undermine that ability to recover and increase the risk the pain will persist after the injury is gone. COVID-19 has essentially chronified America’s pain. Increased anxiety, decreased sleep, poor diet, fatigue, social and familial isolation, financial loss, and many other factors have robbed people of their resilience to fight their pain, which then becomes chronic.
But there is also an opportunity here to be seized. Among those not currently using non-drug approaches, 80% would be interested in managing their pain by eating healthier, 71% are interested in trying exercise, 68% in massage therapy, 62% in physical therapy, and 61% in mindfulness-based stress reduction or meditation.
The message is clear: patients want help navigating their pain. They are reaching out for help, but they may not know where to turn, especially our younger patients who are least likely to have a primary care provider.
As health care providers, we must do a better job of educating our patients about the many approaches to pain management beyond pills and procedures. We need to empower them to find lasting solutions that fit with approved first-line treatments for chronic pain.
The American College of Physicians recommends that physicians and patients initially select non-drug therapies such as exercise, physical therapy, acupuncture, mindfulness-based stress reduction, tai chi, yoga, spinal manipulation, and cognitive behavioral therapy to address chronic pain – especially the most common type of pain – low back pain. It’s our job to be well-versed in these new guidelines, even if we weren’t trained in them during medical school.
Cannabis, CBD, nutritional supplements, and off-label medications have many reputed benefits for various ailments and increasing numbers of patients are taking them. But we must rigorously educate our patients about the evidence, limitations, dangers, and alternatives for treatments that are not scientifically grounded.
We owe it to our patients to get educated and help them make evidence-based decisions to manage their pain. In treating thousands of patients, I have learned over many years to not simply ask, “What’s the matter with you?” Rather, I try to learn, “What really matters to you?” In this way, I attempt to discover what health really means to them, what they might be willing to try, and what new pathways we can explore together to move towards healing. I urge you to join me in fighting this growing chronic pain and opioid epidemic.
Wayne B. Jonas is a family physician.
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