Are you in pain? You aren’t alone.

Nearly 1 in 3 Americans suffer chronic pain, from a wide range of injury and disease, at a cost of $600 billion annually (WebMD). The National Center for Health Statistics reports that 2/3 of these people experience pain daily with a severe impact on their quality of life, well-being, and enjoyment of life. 3/4 have low energy, trouble concentrating, and depression. 6/7 report an inability to sleep well—that’s most of them (and that means over 1/4 of all Americans can’t sleep well because of chronic pain).

Pain 1

Over half say they have little or no ability to control their pain. And yet, the National Institute of Health notes that half of people with the most severe pain, or pain as the disease itself, still rate their overall health as “good” or better than good. Ever see people discussing their pain? One says his knee hurts, the next says that’s nothing compared to her headaches, the third says to be glad they don’t have his back pain . . . and whoever has the most pain wins.

There’s no real incentive to treat pain if you feel you’re in good health. So we do the next best thing—treat the symptoms. And that generally means (or at least includes) drugs. Pain is the second largest pharmaceutical category after cancer drugs.

Pain Pills

“In most countries, the use of opioid prescriptions is limited to acute hospitalization and trauma, such as burns, surgery, childbirth and end-of-life care, including patients with cancer and terminal illnesses. But in the United States, every adult in America can have ‘a bottle of pills and then some,’ ” according to U.S. Surgeon General Vivek Murthy in a CNBC report. Doctors write 300 million pain prescriptions a year, adds Irina Koffler, senior analyst, specialty pharma, Mizuho Securities USA, making a $24 billion market.

With less than 5% of global population, the US consumes over 80% of the world’s opioids. Americans consume 99% of hydrocondone (Vicodin). And 40 people a day die from prescription opiods. Yet the National Safety Council reports that 99% of physicians exceed the recommended three-day dosage limit, with a quarter of them writing prescriptions for a full month, mainly primary care doctors. “Accidental overdoses from Vicodin and other narcotic pain relievers kill more people than car accidents in 17 states now,” says Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Over 2 million Americans are addicted to opioids, reports the National Institute on Drug Abuse. Some move to heroin, as it’s considerably cheaper.

Pain 2

In non-narcotics, reports the American Pain Foundation, 1 in 3 Americans over 65 take NSAIDs (aspirin, ibuprofen, naproxen) daily for chronic pain. These drugs block prostaglandin production, those hormones that set in motion the healing process. Yeah, ironic, no? Painful menstruation, heavy menstrual bleeding, arthritis, and some types of cancer, explains the Hormone Health Network, are all connected to excessive prostaglandins levels, so blocking these reduces inflammation, and hence, pain.

But prostaglandins have a job to do – like protecting the stomach lining from stomach acid – so eliminating them causes stomach bleeding. Newer NSAIDs that addressed this (by targeting COX-2 instead of COX-1 enzymes) turn out to increase the risk of heart disease and stroke. And, all NSAIDs damage the kidneys over time (while acetaminophen damages the liver). Turns out you can’t attack your body’s healing mechanism without ill effect.

Doesn’t make much sense, does it?

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I have great respect for doctors and western medicine. If you need a crisis intervention, these are the people you want—no one does acute care better. But chronic conditions pose a special problem: they have holistic causes. Science works, and works well, by isolating an aspect, testing it, and, with verification, advancing knowledge (and medicine). That’s great when you’ve broken your leg – we know the problem and what to do. It’s not great when your own body is apparently the cause.

This is why, as The National Center for Complementary and Integrative Medicine reports, over 30% of adults use alternative medicine each year. Other than medication, medical doctors generally don’t do pain well, so pain sufferers seek other options. But it’s not the fault of the doctors – it’s the nature of pain itself.

Next time: What is pain?

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