Seventy One Thousand Nine Hundred and Thirty Two, Fifty Three Million and 2024

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By R Carter

What do these numbers represent and what do they have in common? There are 71,932 documented medical conditions in the ICD-10 diagnostic manual. These are all the medical condition which can be billed for by a healthcare professional. Two thirds (2/3) of those list pain as either a presenting symptom or consequence of treatment. One third (1/3) of these have pain severe enough to be treated with narcotic pain medication. Fifty three million (53m), as of 2006 are the number of people who have surgery annually in this country. Most of which required some type of pain management. With 20% of those requiring pain management beyond 90 days and as many as many as 10% requiring pain management beyond one year. Sources: PubMed and National Health Statistics Reports Feb 2017

And yet the rate of surgical procedures continues to increase annually. The rate of procedures performed in freestanding ambulatory surgery centers increased by 300 percent in the 10-year period from 1996 to 2006. This trajectory parallels the rise in prescription opioids in the same time period. If you follow the arguments made by some public health officials and government bureaucrats on prescription opioids, then it begs the question. If the prescribed opioids were unnecessary, were the surgeries unnecessary as well?

Once you take the time to rationally consider all contributing factors, the rise in the number of opioid prescriptions written cannot be so easily explained by such claims as over prescribing. For who in their right mind would agree to have surgery without an assurance of pain management afterwards?

In 2006, an estimated 53.3 million surgical and nonsurgical procedures were performed in U.S. ambulatory surgery centers, both hospital-based and freestanding. In 2010, 51.4 million inpatient procedures were performed in nonfederal hospitals in the United States. This data, and the potential for unintended consequences they portend, explain the continuing, intense interest in measurement of surgical events and opioid prescribing. 

It’s rational to assume the number of elective and non-elective surgical procedures can’t continue to rise; unless there is a corresponding rise in population or a replenishment of those who come to an end of life. In 2018 there were 5,900 births and 731 deaths for every 100,000 population. Or a net increase of 5,170 people each year per 100,000 population. Given an estimated population in 2018 of 327 million people, that’s roughly 17 million new individuals on an annual basis.

Some quick math tells us that with these new additions each year and an annual surgical rate of 53 million, somewhere between 2022 and 2024, every person in the US will have had a surgical or invasive procedure at least once. Is it rational therefore to assume the surgery rate can continue at 50 million people annually beyond this point? And is it rational to assume that in the face of an all-out war on prescribing opioids for pain, people will continue to choose elective surgical procedures?

Healthcare professionals and particularly surgeons are facing a hard choice in the near future, their very livelihoods loom in the balance. At its historic rate of 50 million surgical procedures, by 2024 every individual in this country will have experienced what is like to have an invasive procedure, 20% requiring medication up to 90 days post-op and 10% requiring pain medication beyond a year.

Can the current effort to hold pain medication at a fixed level, stand in the face of a majority population experiencing acute pain that requires something stronger than Tylenol and 30% requiring that something longer than five days? Is the current policy of restricting access to opioids, going to weather an aging population which lives longer with chronic illness including chronic pain? Will the right to die with dignity rather than live with untreated pain; become the next battleground? Or will government force individuals to live with pain, claiming the sanctity of life over its quality? 

But more importantly, is our current healthcare system going to survive what appears to be a brick wall on persuading individuals to elect surgical treatment when facing all these issues? What’s the rationale for living longer if that life is plagued with pain?

As someone who treated pain for nearly thirty years, when I consider all these facts I can’t help but come away with a conclusion that the current policy of restricting access to opioids for medical use as a means of addressing an opioid abuse problem, is essentially a policy which has its own death sentence written into it. It’s simply not sustainable for these reasons.

  • People who require surgery as a means of life or quality of life or death, will object to not having adequate pain management.
  • People who face elective surgery or living with a health complication, will choose the complication over the risk of becoming a chronic pain patient with inadequate access to pain management.
  • Both of these will result in fewer healthcare interventions which means a reduction in income not just for doctors, but hospitals, labs, clinics, outpatient surgery centers and rehab facilities.
  • The insurance industry wills no doubt love this as they will increase profits as they collect premiums but pay out fewer claims.
  • Pharmaceutical companies will also love this as more choose to manage symptoms with medication rather than surgical solutions.

In all we’re still talking about a several billion dollar a year reduction in revenue for healthcare overall. If anyone is watching how things usually play out, this is when those who have remained on the sidelines get off the bench and begin to act.

How they act depends on how well we, the chronic pain community shape the conversation and the debate around these issues over the next five years.

Be Radical, Be Active, But Don’t Be a Pushover

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