Pain is a complex condition. The risk of both acute and chronic pain is affected by many factors, including age, race, sex, income, education, urban/rural living, and other demographic factors. Even though chronic pain shares many attributes with other chronic conditions, it has some unique characteristics. One unique characteristic is that pain remains a subjective experience. Contrary to other chronic conditions, it lacks reliable objective measures (such as HbA1c, blood pressure, cholesterol) which can be reliably measured and globally understood by the healthcare community.
Today, pain as a symptom as well as syndrome is widely acknowledged, however its recognition as a disease is only now getting recognized with its own coding, in ICD-11. After this code is accurately used in clinical practice, we hope to get a more accurate sense of effectiveness of various treatments and cost of pain management
Pain is more common than what most people believe. At least 120 million U.S. adults suffer from common pain conditions. About 25% of them, 30 million Americans report daily chronic pain and this percentage is growing every year.
The numbers in workplace are also staggering. 1 in 2 workers experience musculoskeletal pain in any given year, contributing to 15-20% of annual health spend to musculoskeletal pain conditions. Nearly half of employees living with chronic pain (46%) say their pain affected their ability to perform their job.
The number of provider visits by people with chronic pain are two times the visits by people without chronic pain. They also have a considerably higher utilization of urgent and emergency care.
This makes musculoskeletal (MSK) pain the top condition in medicine and public health.
People with pain have complex unmet needs
Pain is a personal experience where the individual’s own perspective needs to be front and center. The unique way each individual perceives pain depends upon multiple factors including biological (illness, injury etc.), psychological (anxiety, fear, depression) and social (work, home, family).
Most people who experience chronic pain are not productive at work and often function at a reduced level. Some of them suffer simultaneously from multiple pain conditions and are completely disabled by their pain. People with chronic pain often have little observable physical pathology or adverse laboratory findings, so treatment can be challenging to manage in a medical context. That’s why despite high frequency of physician visits and high medical spend, these people do not respond well to the traditional medical model of care. Physicians find it hard to assess, diagnose and manage in the space of a 10-minute appointment.
A number of people with chronic pain have comorbidity, the two most common co-morbidities of chronic pain are depression and anxiety. Research suggests that anywhere from 30 to 50% of people with chronic pain also struggle with depression or anxiety.
Pain management multiplex
To respond to the ever-growing numbers and complex needs of people with musculoskeletal (MSK) pain, our healthcare system designed around doctors and hospitals has responded with fragmentation, complexity, barriers and excessive cost.
Pain care in America remains fragmented, inconsistent, and incomplete, with uneven access and disparate quality.
Take Amy Evans, a warehouse manager. What started as an intermittent low back pain – managed via pain medications after multiple physician visits, transitioned to chronic pain in multiple areas, along with sleep disorder, depression and fatigue. This created enormous challenges for her and impacted all aspects of her professional and personal life. She is completely overwhelmed with this complex, uncoordinated, antiquated, interventional system. In every physician appointment, she is expected to compress all of her issues in 10 minutes and after the first two issues, the rest is pushed out to next appointment, and by then she had more issues.
With no advocate at her side, she is trying to navigate on her own, with uncertainly at every turn. Most of them will end up with highly medicalized interventions such as injections and surgeries, often with suboptimal outcomes.
There are millions of people like Amy who found themselves in the same confused situation everyday, unable to understand why the healthcare system in United States neglects them as a person. Many of them are surprised to see physicians and other healthcare providers invalidate their illness experience and show lack of interest in coordinating and managing their care.
There are challenges on the provider side as well. Primary care physicians (PCP) often report frustration when caring for people with chronic pain because of time constraints and their limited expertise in pain care.
This has led to a highly medicalized and interventional system that uses excessive diagnostics, treatments without clear evidence and with high cost and little outcome data. 50% of spend on musculoskeletal conditions is waste and can be avoided. Over-diagnosis is widespread and leads to unnecessary tests and treatments that do not benefit patients, and may cause harms, and waste health resources that could be better used elsewhere.
Personalized, coordinated holistic care
John J Bonica, known as the founding father of the discipline of pain medicine mentioned in the The Management of Pain, that chronic pain has to be considered as a pathologic entity requiring a specific therapeutic approach. The successful management of chronic pain relies on a multidisciplinary and holistic approach aimed at both minimizing pain as much as possible and empowering people how to live well with chronic pain. It has to evolve from primarily one dimensional, medically oriented approach to a multimodal approach that incorporates a biopsychosocial formulation with physiological, cognitive, behavioral, and emotional components. This modern, personalized holistic approach to pain management includes multiple types of interventions working together including physical therapy, self-management, behavioral health support and tailored education.
Advice alone is not enough. The treatment plan must include specific exercise programs tailored to the needs and capabilities of the person, and adjusted on a regular basis. Any form of exercise or activity is good for people with chronic pain.
Physical and occupational therapy also helps in improving functional ability to manage daily activities, which boosts confidence in one’s ability to be in charge.
Behavior health support
People with chronic pain often feel neglected as a person in our healthcare system. They want confirmation that their chronic pain is real and want to feel empowered. Behavioral health support creates a partnered relationship between coaches and members and make members feel significant and heard. 1:1 support and motivation goes a long way in helping people overcome barriers and build healthy habits.
Self-management can be used from an early stage in chronic pain management, with people being directed to self-help resources at any stage in their pain management journey. There is growing evidence that supported self-management, for example self-management programs and electronic delivery including online pain management education is effective. The education can provide tools to manage chronic pain – including pacing activities, sleep management, positive thinking, goal setting and relaxation techniques.
Digital care for pain management
Digital care delivery model is ideally suited for pain management.
It provides easy access to care, which is fundamental for any condition, but more so in pain management where people routinely face delay in receiving optimal treatments. Digital care is also multimodal and allows for asynchronous flow of communication between care team and members. This connected care model is vastly superior to the current model where members are forced to visit providers in specific locations during work hours.
Digital care is also more affordable and promotes conservative care over medically interventional care. Unlike traditional paternalistic approach, this approach is centered around empowering people to be in charge of their health with proactive, continuous care support from their care team.
Sprite Health provides an evidence-based digital care program for chronic back and joint pain. The digital pain management program blends physical therapy, behavioral support and education – to manage discomfort, improve function, and boost overall health and wellbeing of your people suffering from chronic joint and back pain.
Leading employers choose Sprite Health to get better outcomes at lower cost – over 30% cost savings, reduction in unnecessary surgeries, opioid dependence, and absenteeism. In addition, Sprite Health digital musculoskeletal (MSK) hub provides a single point of access for all musculoskeletal conditions at every stage of their journey. From prevention to postoperative rehab – all in one app. One place to go, one app for all MSK care.