CARE MANAGEMENT

Navigating a Fragmented Pain Treatment Landscape in Search of Coordinated Care

NOV 14

Recently we published an overview of the Pain Management market, an important and high growth area of healthcare.

Pain management clinics have traditionally targeted patients with chronic musculoskeletal and neurological complaints.  As the illustration below shows, the market has evolved to include many pain treatment approaches – each suited to address a range of unique pain conditions ranging from migraines and lower back pain, to fibromyalgia and PTSD.  This evolution has resulted in a pain treatment market which is fragmented across both inpatient and outpatient settings.

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We view this fragmentation as one of the more interesting traits of the market and why investments in innovative business and care models and sector consolidation will continue.  As our report highlights, there are many patient populations seeking pain treatment – and the benefits from a more coordinated approach could be economically significant.  Our report assessed five groups:

  • Patients with Chronic Post-Surgical Pain: According to the Centers for Disease Control, total surgeries in the U.S. topped 53 million in 2010. These ranged from large bowel surgeries (500,000 procedures), to Caesarean sections (1.3 million procedures), to knee replacements (719,000 procedures).  Almost all surgeries require some form of pain management, and today these treatments are delivered both in routine inpatient settings, sometimes by hospital pain teams, and also in outpatient and physician office settings.  However, chronic post-surgical pain (CPSP) is a significant and common problem and is associated with increased analgesic use, restricted activities of daily living, reduced quality of life, and increased healthcare utilization.  There are wide variations in the frequency of CPSP after different surgical procedures; however, extrapolating from the rates of CPSP for the ten most common surgical procedures, we estimate that approximately 12 million patients suffer from CPSP each year.
 
  • Patients with Acute (Somatic) Pain: According to the National Hospital Ambulatory Medical Care Survey, 129.8 million Americans visited an emergency department (ED) in 2010, up more than 8% from 2006.  In parallel, the number of EDs across the U.S. has shrunk which puts the remaining facilities under pressure to provide care for an increasing number of newly insured patients in already-overflowing emergency rooms – crowding that reduces the promptness and quality of treatment.  According to the Western Journal of Emergency Medicine, 78% of patients visiting the ED have pain and 40% of them have chronic pain.  These figures suggest that approximately 41 million ED visits per year are for chronic pain issues.  Moreover, patients treated in an ED for acute pain typically receive follow-up care in a different setting, thereby creating the potential for fragmented care, mismanagement, hospital readmission and, all too often, narcotic prescription duplication.
 
  • Patients with Aging-Related Pain: Chronic pain advances with age, and some studies cite that instances of chronic pain can double when people reach 65.  While aging alone doesn’t cause pain, older individuals typically have multiple chronic health issues which lead to declining function and frailty.  Age-related conditions such as osteoarthritis, spinal stenosis, osteoporosis-related falls and cancer are associated with pain in older individuals, and pain medications are often prescribed for U.S. seniors.  In addition, a study of CMS claims data shows that the number of Medicare recipients receiving pain-relieving spinal intervention techniques increased 108% between 2000 and 2008.Unfortunately, pain in the aging population remains largely unrecognized and untreated and is sometimes mistakenly diagnosed as dementia or depression.  It is estimated that 45% to 80% of nursing home residents have substantial pain that is undertreated.  These trends in the elderly are an issue that will only get more problematic considering the age 65+ segment will make up 20% of the U.S. population by 2030.
 
  • Patients with Cancer-Related Pain: According to the National Cancer Institute, up to 90% of cancer patients get relief from relatively simple pain management therapies.  However, one in three patients continues to experience pain after treatment.  In addition, some patients are reluctant to speak up about their pain because either they don’t want to ‘bother’ their doctors, or fear that the presence of pain could mean their cancer is advancing.
 
  • Patients with Psychosomatic PainPsychosomatic pain describes pain for which no physical pathology is present, and frequently occurs in conjunction with emotional disturbances.  While pain is always subjective, the emotional overlay of a behavioral health condition such as depression, anxiety, or post-traumatic stress disorder (PTSD) creates a uniquely complex situation where physical, mental and emotional pain are intertwined.  Unfortunately, this type of pain is frequently misdiagnosed or untreated, and some patients seek potentially harmful drugs as a remedy.


For a deeper dive on the Pain Management sector including our views on best practices for building coordinated approaches to pain care, download the full report, and let us know what you think.

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Chris Hoffmann