Pain Awareness Month, the Opioid Crisis, and Remembering the Patient

Many fingers have been pointed in the struggle to identify the causes – and, by doing so, find solutions – for the opioid crisis. Some have blamed overprescribing doctors; many have blamed the all-powerful drug industry. Others point to demanding patients, who want an immediate fix to their problems.

Few, if any, have discussed the role of the health insurance industry. Until we do that, I doubt we will be able to fully address the epidemic.

Right now, people experiencing pain, whether acute or chronic, have very few nonpharmaceutical treatment options that are truly accessible. Things like physical therapy, massage, chiropractic care, injections, biofeedback, or cognitive behavioral therapy can be effective pain relievers, yet few of these things are well-covered by insurance, if they are covered at all.

To make matters worse, the people who most need effective pain management – those suffering from chronic health issues – are more likely to face financial burdens, whether because their physical limitations impede employment or because the high costs of their premiums are eating away at their income. These individuals often are hard-pressed to find the extra money for weekly PT.

Affordability is one problem, but access is another. Those with serious conditions may have difficulty even getting to in-person treatments. They may have a limited ability to drive or, for those in remote areas, be too far away from the right clinic. Is it any wonder that the opioid crisis has disproportionately affected the poor and those in rural areas?

Take this example from one of our staff members, who lives with debilitating back pain: Her massages cost $60 a session; spine injections cost $100; physical therapy costs $40. She can’t drive, so she has to pay for an Uber to all of those appointments. On the other hand are her prescriptions, which she can have mailed to her house or walk to pick up at a pharmacy nearby. Her nonopioid prescription, Lyrica, is $50 a month. Her opioid prescription, at less than $5 a month, is by far the cheapest, most convenient, most effective option she has.

Living with pain is neither easy or fun; no one chooses it. Every day, those with pain have to fight to take a step, get out of bed, and live a normal life. People with pain will seek pain relief however they can. And if the only way they can afford and access it is in the form of pills, including opioids, that’s what they’ll continue to rely on. Many reforms at the state and federal levels seek to reduce access to opioids without doing any work to increase the availability of alternatives. It’s unsustainable and unfair to people with legitimate pain.


A powerful voice in the pain community and beyond, Paul Gileno is the founder and president of the U.S. Pain Foundation.

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