Javelin Investors Day: Pain Medicine, Filling in the Gaps December 6 2006 Peter S. Staats, M.D. MBA, DABPM, FIPP Adjunct Associate Professor,Department of Anesthesiology & Critical Care Medicine and Oncology Johns Hopkins University School of Medicine
Pain: Time for Reevaluation
Epidemiology of Chronic Pain 20% to 30% of residents in the United States and Western Europe experience recurring pain» Affects almost 90 million Americans Enormous financial burden, mostly in the form of compensation and loss of work» Costs in the United States are more than $90 billion per year in medical costs, disability payments, and loss of productivity Most common types of chronic pain include back pain, migraine, arthritis, cancer, and neuropathic pain Robinson JP. 2001. In: Bonica s Management of Pain. Lippincott Williams & Wilkins. http://www.ninds.nih.gov/news_and_events/news_articles/news_article_chronic_pain.htm. Accessed Dec 6, 2004. http://www.chronicpain.org. Accessed Dec 6, 2004.
Many Americans Suffer from Chronic Pain 86 million Americans suffer from chronic pain 1 66 million are partially or totally disabled 1 8 million are permanently disabled by back pain 2 There are 65 thousand new cases of permanent disability diagnosed each year 2 1 Medical Data International, Report 1620, Pain Management Products 2 Medical Data International, op. Cit.
Pain: Scope of the Problem The High Cost of Recurrent Pain Recurrent pain costs as much as $90 billion in doctors fees, drugs, compensation and litigation expenses. Back pain, migraines and arthritis costs can reach $40 billion and 50 million lost work days. Nearly 1/4 of lost work days are attributable to pain. Pharmaceutical Companies are estimating 35 billion in sales in the 2003 for pain Business Wire, American Pain Society
Pain Has a Significant Impact on the Individual and Society Pain is a leading cause of health-related absenteeism 13% of the US workforce experiences lost productivity due to common pain conditions Workers with back pain lose an average of 275 hours per year of productivity time (Stewart, 2003; NPC/JCAHO, 2001)
Patient-related Pain Is Under-treated» Delay seeking treatment» Fear of pain medication Fear dependency or reduced efficacy if taken too often» Difficulty communicating pain symptoms Clinician-related» Under-assessment of pain» Inadequate understanding» Lack of consensus among professionals Divergent views on opioid use System-related» Lack of access to pain management services Barriers in the health care system» Legal ramifications of prescribing Schedule II and III drugs Bostrom M. J Pain Symptom Manage. 1997;13:166-168. Jacobson L, et al. 2001. In: Bonica s Management of Pain. Lippincott Williams & Wilkins. American Pain Society. Pain: Current Understanding of Assessment, Management and Treatments. July 19, 2004. Available at http://www.ampainsoc.org/ce/npc. Accessed Dec 9, 2004.
Nonmalignant Pain Treatment Algorithm: Over the counter drugs Fix the Disease Ultracet/Lidocaine Patches Adjuvant analgesics Physical Medicine and Rehabilitation Therapy Cognitive-Behavioral Therapy Therapeutic Nerve Blocks Surgery Directed at Presumed Cause Weak and Strong Opioids Spinal Cord Stimulation Implantable Infusion Systems Neurolytic Blocks Neuroablative Therapies
Balance Risks Pain Opiates and
WHO Analgesic Ladder
FRIDAY, FEBRUARY 9, 2001 Cancer Painkillers Are Being Abused on Streets, by Francis X. Clines with Barry Meier Scott Hopkins, a Kentucky state police trooper, took into custody one of 200 people arrested on suspicion of dealing the drug (Oxycontin).
Summary Pain will become an increasingly important problem in the coming century The trend towards a careful balance on appropriate prescribing versus diversion is likely to continue The pain space in the pharmaceutical market has tremendous potential, but must be done carefully
E LAUHOE MAI NA WAA I KE KA I KA HOE I KA HOE I KE KA PAE AKU I KA AINA Out of perpetuation of ancient wisdom, in harmony, with the promise of a new tomorrow.
For More Information Premier Pain 732-380 380-02000200 National Pain Foundation Painconnection.org American Pain Medicine» PO BOX 678» Holmdel NJ 07733