Columnist Judy Foreman On Rampant Under-Treatment Of Pain

Health columnist Judy Foreman

Judy Foreman, perhaps the best-known health reporter in Boston and a nationally syndicated columnist, is now in pain. That is, she is writing a book about chronic pain — titled “A Nation in Pain: Healing Our Biggest Health Problem” –and is deeply immersed in the subject. She has kindly agreed to drop us an occasional post about the world of pain, and here is her first:

There’s a dynamite piece in the Jan. 19 New England Journal of Medicine that I would urge anybody in chronic, severe pain to read.

It’s written by Dr. Philip Pizzo and Noreen Clark, who chaired the committee of pain specialists who wrote an important report last June for the Institute of Medicine, an arm of the National Academy of Sciences. Pizzo is dean of the Stanford University School of Medicine and Clark is director of the Center for Managing Chronic Disease at the University of Michigan.


Medical schools barely teach about pain, even though pain is the main reason people go to doctors.


In their New England Journal piece, and in the lengthy Institute of Medicine report itself, Pizzo and Clark argue eloquently that under-treatment of chronic pain is rampant in this country, that we have a “moral imperative” to do better and that many patients in severe pain understandably see their doctors as “poor listeners.” (I can vouch for this personally: The first doctor I saw during an 8-month bout of severe neck pain a few years ago suggested my pain was an emotional problem.)

As Pizzo and Clark say, “the magnitude of pain in the United States is astounding.” More than 116 million Americans live in some degree of chronic pain, and this figure doesn’t even include kids, people in the military or people in nursing homes. The cost is astounding, too: An estimated $560 to $635 billion, more than the costs of cancer, heart disease and diabetes combined.

For me, the most egregious problem is that, as the Institute of Medicine report documents, medical schools barely teach about pain, even though pain is the main reason people go to doctors. A Johns Hopkins survey of 117 medical schools last year showed that doctors learn appallingly little about pain in med school. Other data show that only half of primary care physicians feel even “somewhat prepared” to deal with patients in pain.

As a nationally syndicated health columnist, I have become so concerned about the chronic pain epidemic that I am writing a book on it for Oxford University Press and the International Association for the Study of Pain, an academic group.

As a journalist for almost 40 years now, I have watched with awe and deep respect as people with breast cancer, AIDS and disabilities have cast aside the stigma and isolation and insisted on more respect and better treatment. I think people with chronic pain — and those who love them — should do the same.

Please follow our community rules when engaging in comment discussion on this site.
  • Nancy


    I am SO looking forward to reading your book? When can expect it in stores?

  • Doc ForthePeople

    I feel an immense gratitude for your willingness to speak out against a media tidal wave of villainizing pain sufferers. Please know that doctors are not only not taught about pain, they are currently under immense and real threat of regulatory sanctions for treating it!

    • Anonymous

      Doctors refuse to have education in pain care- they fought the fda when the fda wanted all doctors to have education on opioids. The so called experts in pain care refused to support legislation in NYS – SB 2723 and A 4661 which would require doctors to have education in pain care. The simple truth is doctors really dont care about people suffering pain. They chose instead to excuse themselves by saying the DEA wont allow them to treat pain-when most of them are so uncaring to have any education at all in pain care. And the experts -in pain care- including most of them who wrote the IOM report know little about pain care beyond Bonicas Pain Management. Lets face the facts -unless the public repeatedly and energetically petitions their legislators we wont see much improvement in pain care. The dried voices of people in pain -and those who depend on them will remain mute and meaningless and distant as fading stars until their is radical change in medical care- and modern turnstile medicine is too unregenerate and morally lazy to make that happen-in fact they energetically resist efforts at reform.

  • Anonymous

    Lack of education in pain care is the most frequented mentioned barrier to improving pain care. But clearly both government and medicine has been satisfied with the sorry state of affairs of poor pain care for over 50 years. Despite considerable documentation from medical journals that pain care for every condition from migraines to plantar fascitis-medicine  continues to neglect people in pain-and now more and more medicine wishes to project responsibility onto the victims of poor pain care. People in pain and those who care about them voices will remain mute and meaningless and as distant as fading stars until medicine and government become more humane.

  • Reasonable?

    Speaking from personal experience, medical students are exposed to pain management but a largely confused by it.  On a typical hospital ward there will be patien on PCA pumps, dilaudid patches, oral oxycodone.  That’s pretty normal.  What’s challenging is knowing whether you’re giving too much or too little. Is the patient in genuine pain or medication seeking?  We have exteremely powerful drugs for pain, but it’s hard to manage a subjective process.  And what I’m describing is the inpatient process.  I’d imagine things are aso challenging in the outpatient context where the feedback loops are much longer.

    • Anonymous

      A recent study showed 70% of doctors failed basic test of musculoskeletal knowledge. It is well known that most pain is musculoskeletal. Doctors refusal to take pain seriously represents moral and mental laziness and ignorance. It is as unprofessional as it is inhumane. It is time for Americans to require all people treating pain to have real pain. As things are now the joke is most doctors missed the 2 hour lecture they might receive on pain. It is unfortunate the above commentator is blase about pain care and his opinion reflects the fact that modern medicine continues to fail not only individuals in pain but the great costs to the larger society. Doctors should no longer be allowed to fiddle while people in pain burn. Lets enforce the prohibition against cruel and degrading treatment that Human Rights Watch has advocated by requiring all doctors to have real education in pain care and let us weed out those doctors who are not morally or mentally ready to provide professional and human care to people in pain.

      • Reasonable?

        It’s probably better to have better protocols for pain management by condition than to try to cram more detailed information into the heads of doctors.  Physicians are acutely inundated with the data overload that the rest of society is facing.  However in medicine there is still a widely held tacit belief that doctors can memorize and recall massive amounts of detailed data at the drop of a dime.  The human brain just doesn’t work like that (and doctors ARE human).  So I suspect doctors randomly quized on a myriad of clinical topics would do poorly unless they had studied it recently or it was a part of their practice.

        Unfortunately pain management is a case in point of this general problem.

        • Anonymous

          Dr Story Landis of the federal pain consortium indicated in 2008 that treatments for pain are “woefully inadequate”. The texas Pain initiiatives report indicates there is “massive failure to assess and treat pain”. A Call to Revolutionize Pain Care In America- written in 2009 indicated that pain has been tragically overlooked in medicine.
          Clearly physicians have willfully ignored the cries of people in pain and those who care about them. A recent study showed that on average physicians know all of 3 medications for pain. Another study showed that physicians say the biggest barrier to pain care is they are unable to diagnose pain. Its regrettable that physicans remain so uninformed about the issue of pain. The medical profession will need to be reformed by those who have compassion for people with pain- for physicians care little for people in pai n as Dr Gawande and others and medical research itself has documented for over 40 years. I recommend Reasonable educate himself as to the facts of poor pain care before proving to others what most Americans already know-that doctors and medicine don’t care much for people in pain

  • Ray Welch

    “There’s a dynamite piece in the Jan. 19 New England Journal of Medicine that I would urge anybody in chronic, severe pain to read.”  If you want to read this “dynamite piece” you have to buy it.

    • Anonymous

      I disagree- this piece represents the occupational strategy of pain managers to obtain funding for pain management- clearly they are opposed to cures for pain for in the IOM report on pain they clearly state they dont believe in cures for pain. Dont assume the so called experts haave as much expertise as they claim- for they know little beyond what is in Bonicas Pain Management. As Einstein said you cant change a problem with the same consciousness that cretaed it- the pain managers represent the same old consciousness that has lead to the sorry state of affairs in pain care today.

  • Bridget Russo Elmeniawy

    I just want to thank you for bringing this issue into the light of day!  I could also fill a book with stories of doctors telling me that the pain is all in my head.  Those of us with chronic illness indeed deserve much more respect from our caregivers.