Relief from chronic pain might be something you can’t obtain. Not because the relief doesn’t exist, but because you may not be able to access it.

 

About a month ago, I had breast reduction surgery in attempt to address the chronic pain I have felt for decades. I had been living with chronic back pain, daily headaches, and upper body weakness due to my trapezius (traps) muscles being constantly tight. I could hike for miles but could only do basic arm circles for maybe 20 seconds.

I was told my pain was due to dehydration, nutrition, posture, and lacking muscle strength. No matter how many times I tried to explain to medical providers that I suspected my pain was due to my breast size, they would wait a half a beat and then launch into how they were going to treat the pain, with pharmaceuticals, referrals to PTs, strengthening exercises, and dry needling.

What is the impact of chronic pain?

Chronic pain is pain that lasts 3 months or longer, and the CDC estimated in 2021, almost 21% (51.6 million people) of Americans experience chronic pain. The NIH estimates this number is closer to 100 million. Chronic pain has been linked with depression, Alzheimer disease, higher suicide risk, and substance use and misuse.

The same 2021 study showed that chronic pain impacted:

• • • American Indian or Alaska Native adults 2x more than White adults,
    • Bisexual adults about 50% more than straight adults.
    • Rural adults 2x more than urban adults
    • Adults at or below the federal poverty level 4x more than adults with a family income higher than 400% if the poverty line.
    • Women (21.7%) more than men (19%)

What are the obstacles to accessing treatment?

Chronic pain greatest impact is on those who struggle most to access medical care. Medical providers are more likely to dismiss pain complaints made by people of color and woman, attributing the complaint to drug seeking or stress, respectively. Most of the medical centers are in urban areas, with more and more rural hospitals closing. However, one of the greatest obstacles to health care in the U.S. is the ability to afford it.  

My surgery was not covered by my health insurance, the biggest reason I was in pain for years. The two years prior to my surgery, I was going to the chiropractor every other week to dry-needle my traps, just to keep the headaches at bay. Eventually, I took out a personal loan for my surgery.  

A 2013 survey by the Kaiser Family Foundation found that 26% of women reported they delayed or went without medical care due to the cost.

A quarter of women reported they went without medical care because they didn’t have time to go to the doctor. Many women, especially low-income, don’t have paid sick days to go to appointment after appointment.

When I woke up from surgery, my back pain and headaches were gone. Two weeks post-op, I had my traps dry-needled, and they were no longer tight. I had to pay $15,000 to address my chronic pain because insurance companies don’t believe breast reduction is medically necessary.

Every day, I work with clients with chronic conditions who struggle to pay for pain and symptom relief.

• • • The Autoimmune Association outlines how health insurers create obstacles for patients and doctors to access treatments and medications for a variety of autoimmune diseases.
    • Most health insurance plans require patients go to physical therapy prior to approving surgery, requiring time-off work and paying co-pays for each appointment.
    • Hematopoietic stem cell therapy (aHSCT) may be able to stop or slow the progression of MS. In a 2016 study, nearly 70% of people who received aHSCT showed no new lesions after 3 years. But the FDA hasn’t approved it to treat MS, which means insurance companies won’t pay for it. It is estimated to cost $125,000 out of pocket.
    • Mesenchymal stem cells have shown promising results in clinical trials for lupus, MS, and rheumatoid arthritis. The FDA hasn’t approved MSC for use in the U.S. Whereas, the EU, Canada and Australia have approved treatments. With many Americans pay $10k-$30k to have treatments done in Panama.
    • Mayo Clinic is ranked among the top hospitals for rheumatology, treating connective tissue autoimmune disease. They specialize in treating hard to diagnose autoimmune diseases. They also are doing dozens of clinical trials for autoimmune disease and their autoimmune neurology is focusing on biomarkers and have the largest patient sample collection in the U.S. Insurance companies may cover treatments, but not clinical trials and patients still have to pay to travel to one of their campus in Minnesota, Arizona or Florida. 
    • One of the top endometriosis surgeons in the U.S. is located in Atlanta and is an out-of-network for all insurance companies. Though they will submit claims to your insurance company for you, unless you have met your out-of-network deductible, you may still be responsible for the full cost of surgery out of pocket. Another top endo surgeon is in Palo Alto, CA and does accept insurance but some plans don’t cover out-of-state procedures. And you need to pay to travel to, and recover in, these cities. One surgeon’s website stated out-of-area patients should plan on staying 8 nights in the city. 

So, what’s the solution?

The NIH estimates the economic cost is from $560 to $635 billion, including health care costs, days of work missed, hours of work lost, and lower wages. This is more than the economic cost of heart disease ($309 billion) and cancer ($243 billion).

As it is with most things, the solution isn’t a straight answer. As a systemic therapist, I am going to point to just a couple of things that are getting in the way:

• • • the lack of research into chronic pain, what it is and why it happens.
    • the power private insurers have in our lives. Healthcare shouldn’t be about profits and shareholders.
    • U.S.-centric propaganda and racism that claim healthcare in other countries isn’t’ as safe or regulated as it is in the U.S.

Do you experience chronic pain? What has the cost been for you?

This blog post is for informational purposes only and does not create any type of therapeutic relationship. For specific assistance, please consult your own medical and/or mental health provider.