Date of Award

2000-05-16

Degree Name

EdD Doctor of Education

Dissertation Committee

Susan M. Zgliczynski, PhD, Director; Jerome Ammer, PhD; Bill McCarberg, MD; Samuel Herrick, PhD

Keywords

Chronic pain, Cognitive-Behavioral Pain management, education, gender, Health Maintenance Organization--HMO, Opioid medications, quality of life, quantitative, self-management, southern California

Abstract

The factors involved in the successful self-management of chronic pain are not well understood. Many issues complicate addressing these factors. Individual suffering, exhaustion of family resources, and the costs to society for medical care, lost wages, welfare and disability benefits demand increasingly more resources each year. At the micro level, patients who live the daily rigors of chronic pain want medical science to solve their malady. At the macro level, health plan administrators want their patients to successfully self-manage pain with the least medical intervention and cost, because they know a cure is not probable. In the middle, the medical provider must balance the patient's needs with the limited resources of the medical system. As managed care becomes the fountain of medical treatment, health care systems must apportion the magnitude of services and quality of life only as far as it balances with the bottom line. Chronic pain is one of the most frustrating problems facing medical practitioners today because research has yet to provide definitive solutions. While researchers, pain specialists, and patients demand adequate pain control, including the aggressive use of opioid medications, front-line providers, medical review boards, governmental regulators and society fear the potential crossover into addiction. Medical science can offer care, compassion, pain management, and some modalities of treatment, but a cure is unlikely. In a quantitative study, I examined various characteristics of chronic pain patients, their environments, and their utilization of the health care system, including outpatients' office visits and opioid medications. Included was an analysis of available data on 2,561 patients referred to a cognitive-behavioral pain management program in a Southern California HMO. Employing a linear model, I explored statistical relationships of various factors and their apparent importance in managing chronic pain. Briefly, chronic pain knew no boundaries. Demographically, pain was similarly reported irrespective of age, gender, marital status, education, employment, or disability. Also, the higher the reported level of physical pain, the more pain affected each aspect of one's quality of life. The collected data suggested that chronic pain was under treated in the health care setting and that women received significantly less opioid medication to manage pain. People who were referred to an education-based, cognitive-behavioral pain management program reported significantly less pain and utilized fewer health care services over time. Patients attending the program reported high levels of satisfaction and found the pain management tools useful. However, financial outcomes were similar among patients who attended the program, those who dropped out, and those who never attended class. This population, at best, taxes health care resources at a rate of four times that of the mean population. If, as it appears, chronic pain patients were consistently under treated for pain, educational programs for patients will not significantly impact medical costs. Only when the current pain management standards of care are in place and established treatments for chronic pain management are supported by health care providers would we expect the financial aspect of pain management to improve.

Document Type

Dissertation: Open Access

Department

Education

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