Stanford’s Sean Mackey, MD, PhD, on “The National Problem of Back Pain”

Stanford’s Sean Mackey, MD, PhD, on “The National Problem of Back Pain”


SEAN MACKEY: I’m going
to kick things off with talking about the
problem of back pain and probably more
importantly what we can all do to work together
to help solve this problem. So to no one’s surprise,
we have a crisis of pain in this country. You open up any
magazine, any newspaper, and you’ll see reports on back
pain, headaches, neck pain, fibromyalgia, neuropathic pain. But you don’t even need
to open up a newspaper, you can just look to
your left, to your right, talk to a friend, a loved
one, a family member, and we’ll see that this
is an epidemic of pain in this country. And in fact, what we’re faced
with is, based on the IOM report that we put forward,
about one in three Americans suffer from some degree of
chronic pain in this country. Now that ranges from
people like my father who played a lot of competitive
sports in his younger years and had a lot of injuries
who has chronic pain but who self-manages. He won’t see a doctor about it. He won’t even talk
to me about his pain. He’s a little stubborn. And then you have
on the other extreme people who may be
dying at end of life with cancer-related pain, who
have extreme excruciating pain, and everybody in between. It’s a huge problem in society. We also know from the Institute
of Medicine report on pain that it has an astounding
cost to society. Over half a trillion
dollars a year we spend each and every
year on chronic pain. And while we put
forward that pain can be a symptom of another
condition, when it becomes persistent, when
it becomes chronic, it can become a disease
and in its own right, one that fundamentally
impacts just about every organ system in our body. We’re going to focus a lot
today on the nervous system is one of those end organs. We know that chronic pain
reduces quality of life and that throughout this entire
country– and by the way, I recognize we’re
live streaming. There’s a very US centricity to
this is talk here with the IOM. But everything I’m saying
here applies to every country on this planet. We know that pain
is under-treated and that there is disparities
in treatment with disparities across racial and ethnic groups,
socioeconomic status, gender, age, and everything in between. And that despite these numbers
that I’m throwing out to you– the one in three, the half
a trillion dollars a year– I can tell you that the
quality of the data that we have on pain is terrible. It’s terrible. We put forward that we need
better quality data, understand the actual prevalence
of pain in this country, but more importantly,
what treatments really work for whom and under
what circumstances. For that we still have
a lot of questions. We had several
underlying principles in the Institute of
Medicine report on pain. One, and first and foremost,
that pain management is a moral imperative
for everyone who cares for somebody
suffering in pain. That we recognize particularly
for complex, painful conditions that comprehensive
treatment involving interdisciplinary
teams– and we’re going to talk more about the
team sport aspect of pain. Dr. King will talk with
you about that today– that we’ve learned in treating
pain as a public health problem and other
chronic diseases as a public health
problem that we’re much better off preventing
pain than we are treating it. If we can identify those
people at risk before an injury or at surgery, we can work
towards preventing them from going on to
have chronic pain. We also learned that there
is a lot of knowledge already out there. We know a lot about pain. And we need to do a better job
in getting that knowledge out to you and the
rest of the public. And that’s in large part
why we’re here today is to give back. The staff here,
the faculty are all donating their time
because they feel passionately about this issue. And they want to give back
and help present education to all of you that you can use. We recognize this conundrum
of opioids, this tension between, on one hand, these
highly addictive substances that have caused overdose
deaths, addiction, diversion through people
selling on the street and ending up in jail,
and on the other hand, we have people whose lives have
been transformed by opioids for the better and who are
leading productive lives and working on a regular basis. And we recognize that
there’s no simple solution to this very complex problem. We’re all going to have to
come together and provide our own unique perspectives
to this to find solutions and that we all need to do
better in collaboration, particularly
collaborating with you. Collaborating with you
is the key team player. And Dr. King, again, will
talk about as that MVP. And then circling back
around to the fact that pain really is a
public health crisis. And we need to treat it as
such and apply public health approaches to it. We all know that
pain has a multitude of negative consequences. People get emotional distress. They get depressed, anxious. They get angry. Sleep all goes out of whack. And we’re going have a
great talk today on sleep. We’ll be talking more about
the role of emotional distress. And I’m going to be talking in
a few minutes about the role of the brain in all this. They get fatigued. We find fatigue
plays a major role. And then what happens
is people withdraw. You tend to withdraw from
your friends, your family. And what you’re
going to learn today is that that
withdrawal is exactly the opposite of what we should
be doing when we have pain. All of this again leads to a
decrease in quality of life. And many people are
living with this condition without adequate care and
suffer with often little sense of hope. And one of our goals here is
to provide you some more hope. How big is this problem
of chronic pain? Excuse me, how big
is this problem of chronic back pain in the
overall pot of chronic pain? It’s pretty darn big. It accounts for about 28% of all
the chronic painful conditions. And if you add in neck
pain, because the neck bone is connected
to the backbone, it bumps up to about 43%. Huge problem in society. And just about
everybody gets it. It was Benjamin Franklin
who said there’s two givens, there’s two things that
are certain in life, death, and taxes. I’d like to add a
third, back pain. They say by the data about
80% of people get back pain. I think the other 20% have
either forgotten about it or are lying about it. Everybody gets an
episode of pain. And the good news is
that about 90% of people will recover from
that back pain episode after about one to three months. The bad news is about 10% of
people after that episode, or after a few of
these episodes, will go on to have
chronic unremitting pain. And when taken together,
back pain itself has a huge toll on society,
upwards of $30 to $50 billion that are spent each
year in the US alone. And the problem
is getting worse. When you look at reports across
primary care, what you’re seeing is that over
the years we’re seeing an increasing number of
people coming to primary care doctors with a primary
complaint of back pain. This makes sense, doesn’t it? We have an aging population. We’re living longer than
we’ve ever lived before. We also have an
increase in weight which is putting increased
load on our spine. We’re also as a consequence
of living longer, we’re doing this
as a consequence because now we survive the
surgeries that maybe we didn’t in the past. We’re surviving traumas
because of good health care and the emergency
response teams. We’re surviving
wartime, men and women coming back from Iraq and
Afghanistan, for instance. But we’re now living with
the chronic problem of pain as a consequence of that. And so what do we do about this? Well, the good news is there
was a follow-up to the Institute of Medicine report on pain. The IOM report was
a 30,000 foot view of the world, where we needed
to go with pain in this country. The National Pain
Strategy, which was a document that was charged
by Health and Human Services is a tactical plan. It’s a plan on how
we can get there. We were charged– I was honored
to co-chair this with Dr. Linda Porter from the
National Institutes of Health and as
well as 80 incredibly talented and passionate
experts in the area of pain across the country to develop a
comprehensive population health strategy for pain
prevention, treatment, management education,
reimbursement, and research. And this plan had very specific
goals, actions, timeframes, resources. And also, it had accountability. And it was released
in March of this year. And this is a summary of
the National Pain Strategy. It encompass six working groups
that cross-cut all aspects of what we need
to do to transform this country, starting
with population research here where we recognize the
quality of the data is poor. We need better quality data. But we also need to use
that data more effectively. We’re working on that
extensively here at Stanford to better understand
each and every person who comes into our clinic and
then ultimately to figure out what works for whom and
under what circumstance to help obtain the mission of
what President Obama has called for in precision medicine,
what our dean has called for here at Stanford
in precision health. Prevention and care, which
is to increase access to quality care, to better
communicate and understand what treatments work
and let’s use them, and what treatments
don’t work, also to better extend
self-management programs, and to come up with standardized
ways of approaching people with pain. I’ll tell you right now that
for those of you with back pain, if you go to 10 different docs,
who are experts at back pain and get an assessment,
you’re going get 10 entirely different assessments. We don’t have standardized
models for this right now. We need to do better. There are clear
disparities in the way we care for people with pain. There are, as I
mentioned before, ethnic, social, economic status. There’s gender. There’s age differences. And we need to break
down those barriers. We also need to do
a better job in how we reimburse for the care
of the treatment of pain. Right now we often spend money
for things that don’t work and we don’t spend money
for things that do. We need to do a better job in
educating our clinicians, those who care for people with
pain across every level of their training, from
early schooling to people who are out for 20 or 40 years. And then finally, and
perhaps most importantly, we need to do a better job
in educating the public, educating the public about the
importance of this condition, this disease, as well
as, heart of that, a message around safe
opioid prescribing and safe opioid use. We do recognize there is a
prescription opioid epidemic. And we need to get
the message out that your medications
are your medications. We need to keep them
safe and use them safely. Now, if we can successfully
enact this, what will this mean? Well, what it will mean
is that ultimately we’ll treat chronic pain as
the chronic disease that we know it
to be, that we’ll treat it as a public health
crisis that we know that it is. And as such, we will put in
the appropriate resources to be able to provide you with
access to the quality of care that you deserve,
to develop better self-management approaches that
you can use at home to better and more effectively
manage your pain, and that ultimately that you’ll
be treated with the compassion and respect that you deserve. So what can you all do? What can we all do? Well, one is we can put
pressure on the Fed. Talk with your
representatives in Congress. Let them know the importance
of the National Pain Strategy. Download it. Read it. It’s only about 40 page. It’s an easy read. It’s freely available. Get the message out. If you are interested in working
with some of the consumer pain groups, please
reach out to them. A number of them
have banded together under the Consumer Pain
Action Task Force, the CPATF. They brought 16 of these
together to promote the National Pain Strategy. They’d love to
have you involved. If you’re somebody
of means, we’d love to have you help
with your resources. If you’re somebody who knows how
to get the media messages out, help us there. It’s really all going to take
all of us working together to get that cultural
transformation that we all need and the care assessment
and prevention of pain. Thank you. [APPLAUSE]

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