This article appears in the September issue of HealthLeaders magazine.
Physical pain is beginning to define America. Back pain. Knee pain. Spinal disorders. Headaches. Arthritis. Shingles. Migraines. Pain can be here today, gone tomorrow, or a constant presence, gnawing, clawing, endless. Whether sporadic or chronic, pain prompts patients to move from physician to physician, hospital to hospital, seeking the elixir, the magic cure, the one last surgery, even for some tentative relief.
In fact, pain is the most common reason patients visit doctors, hospitals, and health systems. The pain condition is so ingrained that it is dubbed the fifth vital sign by medical professionals.
As such, pain represents a flourishing patient market for healthcare. Hospitals are creating pain management centers with a focus on chronic and acute pain, relying on interventional and multidisciplinary procedures targeting long-term pain.
Pain impacts more Americans than diabetes, heart disease, and cancer combined, and costs the nation up to $635 billion each year in medical treatment and lost productivity, according to a 2011 Institute of Medicine report brief. Hospitals are responding to the booming pain market by focusing on various aspects of care. For hospitals, a key strategy is structuring their pain programs, from evaluating acute and chronic pain, to providing psychological evaluation if needed and patient education.
Hospitals also recognize the need to improve pain management outcomes to improve patient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The HCAHPS survey, which is linked to CMS payments, asks patients about pain management.
Patient pain management is a "big part of patient satisfaction," says Thomas A. Mathew, MD, an internal medicine physician and hospitalist at the 1,100-licensed-bed Christiana Care Health System in Wilmington, Del., which has seen significant growth the past two years in pain management.
For years, its pain management program was part of its palliative care program, but the growth in patients who presented with pain as a complaint prompted the system to create a multidisciplinary team specializing in pain care, including anesthesiologists and interventional radiologists, Mathew says. Over time, pain management has overtaken palliative care.
The 1,158-licensed-bed Barnes-Jewish Hospital in St. Louis expanded the size of its Washington University Pain Management Center from 5,000 to 10,000 square feet to accommodate a growing patient population. In the meantime, it restructured its pain program into two areas, concentrating on chronic and cancer pain in the one area and acute perioperative pain in the other. The Pain Management Center is part of the hospital's Center for Advanced Medicine, and it includes outpatient and inpatient programs.
"We recently moved to a larger facility because of a growing need, with more and more patients to be seen and procedures to be done. You compare year-to-year and month-to-month, and those numbers are going up steadily," says Michael Bottros, MD, director of acute pain service at Barnes-Jewish Hospital and assistant professor of anesthesiology at the Washington University Pain Management Center. "We are seeing a variety of patients, from those with head and neck pain to low back pain to postsurgical pain."
The organization intends to offer pain care for a multitude of service lines. "If you improve patient management, you also indirectly improve everything else," Bottros says. "It has a rippling effect. With service lines such as oncology or surgery, pain is a factor in all of them. It's a common underlying feature. We are ensuring that appropriate pain care paths are developed for the patient based on the condition and the type of surgery they've had."
At the 907-bed Massachusetts General Hospital in Boston, the number of pain patients has increased steadily, from 600 per month in 2007 to more than 1,000 this year. At least 70% are seeking treatment for spine-related pain: chronic low back pain, spinal stenosis, and herniated disks, says Chris Gilligan, MD, MBA, director of the center for pain medicine at MGH. As many as 30% of the patients are treated for other pain conditions, such as musculoskeletal pain, arthritis, shingles, and cancer-related conditions.
With increasing numbers of patients needing pain care, MGH has tried to make treatment more efficient, Gilligan says. For instance, back pain patients are admitted to the hospital's emergency department observation unit instead of an inpatient floor, as had been done previously. Consequently, patient length of stay in the hospital has been reduced, he adds.
"In the observation unit, we perform pain service consults in a very timely fashion," Gilligan says. "If we need imaging and/or injection, they happen quickly and we can reduce length of stay substantially compared to regular hospital admission."
Hospital pain treatment centers are becoming more prominent, especially since many general practitioners are reluctant to become involved in pain management because of their concerns about increased law enforcement scrutiny and widespread misuse of prescription drugs, says Tiffany Meert, chief operating officer of the Northern Nevada Medical Center, a 55-staffed-bed facility in Sparks, Nev. Those concerns have prompted the hospital to become involved in a partnership with a physician group to oversee pain management, she says.