About 75 million Americans suffer chronic pain. But according to Portenoy, there are only 10,000 physicians who specialize in treating pain, and only 5 percent of patients with severe pain actually see a pain specialist.

"You have a situation where the math doesn't work," said Portenoy, chair of the Department of Pain Medicine and Palliative Care at New York City's Beth Israel Medical Center.

However, he said there are numerous obstacles that discourage primary-care physicians from treating pain. These include fear of law-enforcement action for suspicion of overprescribing and concerns about civil litigation for underprescribing.

Portenoy and other pain experts are calling for more education for physicians, regulators and law-enforcement officials; a modification of state policies that hinder treatment; and general changes in approaching pain treatment.

"Physicians are taught that pain is a symptom of an illness. They have to learn that pain is itself an illness and deserves to be approached like other illnesses are approached," said Portenoy. "That's a paradigm shift for the medical schools, and I don't think it's caught on yet."

The American Medical Association, through a $900,000 grant from Purdue Pharma, has released a four-part pain-management series for physicians, as well as an online continuing medical education series.

In addition, the Federation of State Medical Boards held a workshop in November for regulators to assist medical board and law-enforcement officials in distinguishing between criminal activity and medical care in dispensing narcotic prescriptions.

"There's a lot of passion behind the fears that we'll leave people in pain or that we'll have a nation of addicted people," said internist Scott Fishman, M.D., president-elect of the American Academy of Pain Medicine. "The definition of hysteria is often conflicting fears, but both of these fears have some basis in reality."

COMMENTS ON THIS ARTICLE:

Posted by Rudy Warnock on 10 Apr 08 06:29 PM EDT

I suffer from pain everyday, all day and night long. I can't get a doctor to help me with my pain. In Kentucky no doctor wants to or will not help me. Do you have any suggestions?

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