Q&A: Survey serves as ‘wake-up call’ to physicians regarding chronic pain management

A recent online survey of 2,063 U.S. participants showed that younger adults were more likely to experience chronic pain than older adults.

Specifically, the survey, conducted by The Harris Poll on behalf of Samueli Foundation, revealed that 65% of respondents aged 18 to 34 years and 52% of respondents aged 35 years and older experienced chronic pain.

Other survey findings demonstrated barriers to chronic pain care, with 75% of adults aged 18 to 34 years reporting that they did not “know what kind of health care provider can best help them manage their pain.”

In addition, the survey showed that:

• 32% of adults aged 18 to 34 years reported back pain, making it the most common area where pain was reported, followed by 20% who reported either neck or knee pain;
• 29% of those aged 44 years and younger are talking to their doctors more often about their pain since the pandemic began, compared with 15% of those aged 45 years and older; and
• 22% of those aged 44 years and younger use cannabis or CBD oil to treat their pain, compared with 11% of those aged 45 years and older.

“It is clear that young people are trying to deal with their chronic pain on their own, but they also want and need their providers’ help in determining the most effective treatments for their pain,” Wayne Jonas, MD, executive director of integrative health programs at Samueli Foundation and a former director of the NIH Office of Alternative Medicine, said in a press release. “Primary care providers, who manage most patients with pain, should steer their patients — especially young adults — to proven, effective strategies to manage their everyday pain.”

According to additional survey results from participants who said they experience chronic pain:

• 78% said they used nonpharmacological therapies, while 70% said they used pharmacological ones to reduce their chronic pain;
• 80% of those who used nonpharmacological therapy said they would be interested in attempting to follow a healthier eating plan to ease their pain, while 71% were interested in trying exercise, 68% were interested in massage therapy, 62% were interested in physical therapy and 61% were interested in mindfulness-based stress reduction or meditation; and
• 53% said they used an over-the-counter treatment to reduce their chronic pain, followed by 43% who said they exercised, 34% who said they used heat and/or ice, 26% who said they ate healthier, 16% who used cannabis or CBD, 15% who used either physical therapy or massage therapy and 14% who used yoga.

“This should be a wake-up call to physicians that their patients are looking for more information from them about managing their chronic pain, especially for non-drug approaches,” Jonas said in the press release. “It is up to providers across the health care system to engage in regular conversations with patients to uncover the best ways to manage their pain on a daily basis.”

In an interview with Healio Primary Care, Jonas discussed the survey findings, current evidence on the use of CBD and cannabis for chronic pain, when to refer a patient to a specialist and more.

Healio Primary Care: Why do you think younger people reported experiencing chronic pain more often than older people?

Jonas: This finding was a bit surprising, because we usually think older people have more arthritis and chronic health problems.

Chronic pain is a continued pain felt for 12 weeks or more from traumas, stresses, strains and irritations the body produces as well as, in some situations, the lingering effect of an incident that triggered acute pain. Psychosocial stresses occur more in young people with the pandemic, since they have been more subjected to stresses such as losing their job, being home with the kids more often and trying to get on with a reduced income if they cannot work virtually from home.

Healio Primary Care: Why do you think, as the survey suggested, patients are more often talking to their doctors about chronic pain?

Jonas: One reason could be that those who have an injury that they would normally recover may be now trying to recover under stress, without sleep or on a poor diet or are overweight.

Another reason is that chronic stress can cause mental health problems such as depression and anxiety. There are data showing that the COVID-19 pandemic is causing an epidemic of mental health conditions. However, because of the stigma attached to poor mental health, people do not necessarily want to come into their doctor’s office and say, “Oh, I've got a mental health issue,” or “I'm depressed or have anxiety,” but they will come in and say, “My back hurts.”

Healio Primary Care: What does current evidence suggest about the benefits and harms of using cannabis and/or CBD oil to treat chronic pain?

Jonas: Right now, the best evidence indicates that cannabis and CBD oil may be most useful for neuropathic pain that sometimes accompanies diabetes and chemotherapy treatments.

However, most chronic pain among young people is musculoskeletal in origin, and there is inadequate evidence for the use of CBD and cannabis for this purpose. Therefore, the people who use CBD for that purpose may be using it inappropriately.

Healio Primary Care: What should physicians be telling patients who use cannabis or CBD oil about cannabis use disorder?

Jonas: Anytime a patient repeatedly uses something like that, they are at risk for developing side effects such as addiction. Using these products for chronic pain is like trying to put a Band-Aid on something that requires deeper investigation and management. But it does indicate that physicians should look at cannabis as an attempt to self-treat; those patients are trying to take pain management into their own hands. We should acknowledge that and look for ways to help them appropriately manage their pain.

Healio Primary Care: What complementary and alternative medicine options can PCPs recommend to patients with chronic pain?

Jonas: There are several non-drug or complementary and integrative medicine approaches for chronic pain and we have pretty good research to demonstrate that they are safe and effective.

The American College of Physicians has shown that therapeutic yoga can be very effective for back pain, as can massage and mind body techniques. Those would be the treatment options I would recommend physicians guide their patients toward and help provide.

Healio Primary Care: What is a PCP’s role in managing chronic pain? When should they refer patients to a pain specialist?

PCPs are the most likely provider to help patients manage their chronic pain. But pain that goes along with lost bowel or bladder functions requires immediate specialist’s care; thus, patients who experience this should be quickly referred for a specialty evaluation. The other red flag for referral to a specialist is pain that goes on longer than 3 months and has not benefited from nonsteroidals or non-drug approaches, even if it does not cause lost bowel or bladder function.

Healio Primary Care: Is there anything else on this topic you would like to add?

Jonas: Very few physicians have been trained in using non-drug, complementary and integrative approaches for chronic pain and some may not know how to access such training or be reimbursed for it.

The Samueli Foundation partnered with Tufts University to produce a free complementary and alternative medicine course where users can get credit for 4 hours of CME in those approaches. It can be found at www.integrativepaincme.com.

Reference

Adults under 35 who experience chronic pain are more likely to use cannabis or CBD to manage it. https://www.eurekalert.org/news-releases/932742. Published Oct. 27, 2021. Accessed Nov. 19, 2021.