As an anesthesiologist, Gary Koehn, M.D., worked long, "ungodly" hours in the operating room. And he toiled anonymously; patients rarely knew his name.
Then about five years ago he decided it was time for a change. He became certified in the medical subspecialty of pain management and established a new practice, Illinois Pain Consultants. He set up clinics in two hospitals--one in LaGrange, Ill., and the other in Morris, Ill.--where he and a team that includes physical therapists and psychologists treat people with chronic and other types of pain.
Now, he says, life is great. The hours are better, and patients look forward to seeing him. He treats 350 to 400 patients a month; they suffer from headaches, lower-back pain, post-surgery pain, cancer pain and more.
Even when Koehn is able to reduce a patient's pain only by half, he knows he may have enabled that person to do twice as much activity as he or she could do before. His patients are grateful, he says. "Nobody knows their anesthesiologist, but everyone knows their pain doctor."
As Koehn's own popularity has grown, so has that of his field. The reasons are many, industry observers say: The population is aging, which means the number of people who suffer from the aches and pains associated with getting older is growing. Plus, patients today are better educated; they surf the Web for up-to-the-minute medical information, and they read the myriad articles and books about medicine that have flooded the market. Not surprisingly, they now demand that doctors--who once dismissed chronic pain as hypochondria, stress or neuroses--recognize pain as a legitimate complaint, worthy of treatment.
And somewhere in that equation is the good news that these days, doctors have better tools available to ease pain.
The treatment of chronic pain earned $3.97 billion in 1998, a 69.7% increase in value since 1990, according to a recent study by MarketData Enterprises, a Tampa, Fla.-based market research firm. The firm predicts that the field will continue to grow, increasing its revenues to $5.4 billion by 2003.
The impressive growth stems from increasing recognition that pain is a major health problem, says Penney Cowan, founder of the Rocklin, Calif.-based American Chronic Pain Association. Pain management is getting a lot of attention these days, not only in publications and broadcasts geared for consumers but also within the healthcare industry.
"There is a much better understanding in the medical community that pain is a symptom that needs to be treated," Cowan says.
Supporting Cowan's claim was the August announcement by the Joint Commission on Accreditation of Healthcare Organizations of new pain management standards, due to take effect in January 2001.
About 9% of adults in the United States suffer from moderate to severe chronic pain, according to the Glenview, Ill.-based American Pain Society. In 1998, 4.8 million people were treated for pain, 65% of whom complained of lower-back pain, says John LaRosa, research director at MarketData. Several types of programs exist to treat pain, including hospital-based inpatient and outpatient clinics and freestanding programs run by independent pain specialists. MarketData estimates there are about 3,900 pain programs and clinics in operation and that anesthesiologists see about 72% of pain patients.
Yet even with all that's in place, healthcare providers can do a lot more to improve the assessment and management of pain, says Carole Patterson, deputy director of the JCAHO's department of standards. The need for improvement is the reason the JCAHO is introducing standards for care, she says. "While people recognize the pervasiveness of the problem, the evidence is quite clear that pain is not being managed well."
By implementing standards for the treatment of pain, the JCAHO hopes to encourage healthcare providers to look for more efficient and effective ways to handle pain of all kinds, including post-surgery pain, cancer pain and pain from injuries, Patterson says. Before the standards are implemented, the JCAHO will help to educate providers on ways to improve pain management. The commission will hold a national symposium on the topic next year and is looking for examples of innovative pain management strategies to showcase.
Effective pain programs have several things in common, Patterson says. Most importantly, care providers at pain clinics--unlike some of their colleagues elsewhere--recognize that every patient has a right to be assessed for and treated for pain, she says. Good programs also have practitioners who collaborate and work as a team, she says.
Too often, medical centers treat pain in a disjointed way, says Fred Davis, M.D., president and co-founder of ProCare Systems of Grand Rapids, Mich.
ProCare works with hospitals to combine their pain treatment resources into single operating units. The company also educates physicians about pain management techniques that can be performed at the primary-care level.
Pain management programs often serve as resources to physicians who try, but are unable, to treat patients' pain on their own, Davis says.
"We have more effective medications, a better understanding of the psychology of pain and better physical rehabilitation techniques. When you put these things together, you really can impact a majority of pain problems."
Patterson says hospitals usually can create a formal pain program with existing staff, facility and equipment resources, so implementation does not have to be expensive. "There may be some initial costs to designing the program and training people, but in the long run, pain programs reduce lengths of stay and a hospital's costs go down."
ProCare, for example, has worked with several small and large hospitals to set up pain management programs and has been able to reduce costs in the process, Davis says. "Aggressive pain management after surgery or trauma, for example, can reduce stays in expensive critical-care units. Physicians can move patients into areas of the hospital or health system where care is less expensive."
Pain management clinics also have helped reduce emergency room visits by headache patients, ProCare has found. In some hospitals that have implemented pain clinics, headache-related visits are down by 90%.
The demand for pain management programs is clear, says Koehn of Illinois Pain Consultants. "The market for pain care is incredible. We need more physicians to cover all of the patients who need pain care."
Koehn, who worked with ProCare to launch his practice, says the rewards of pain management are numerous. For example, he cites the elderly woman he treated for back pain who can walk to church now instead of having to depend on her family for rides, and the man who was in so much pain from a back injury that he was unable to continue physical therapy. Now he's back to therapy and back to work.
"It's great," Koehn says. "I get to see people get better."
MargaretAnn Cross is an Allentown, Pa.-based freelance writer.