Economic implications of pain management.
BACKGROUND
Economic issues in pain management affect the patient, the provider and society. This paper will review some of the data on the costs to society of chronic pain and its associated disability. It will also look at the costs to patient and provider of alternative economic models. Conceptual issues that underlie health care delivery and the attendant costs must be addressed if society is to gain control over runaway health care costs and reduce the economic burden of chronic pain and disability for the patient as well as the provider.


METHODS
Literature review and synthesis.


RESULTS
Chronic pain is the primary cause of health care consumption and disability in the working years. Multidisciplinary pain clinics have proven utility. Data on efficacy of most other kinds of care is lacking. Disability costs are related to conceptual inadequacies and the medicalization of post-industrial societies.


CONCLUSIONS
To control inappropriate care and escalating costs, we must change concepts of pain and disability and the methods of funding both of these in relation to chronic pain. The outcome of the continuing struggle between the profession of medicine, the state and capitalists will determine how and whether pain management is a part of medical care.
Loeser
J D
JD
Department of Neurological Surgery, University of Washington School of Medicine, Seattle 98195, USA.
D002908:Chronic Disease; D006801:Humans; D010146:Pain / Q000191:economics* / Q000453:epidemiology; D059408:Pain Management; D014481:United States / Q000453:epidemiology