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The Affordable Care Act – Hope for Women in Pain--An Editorial

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It is no secret that women make up a majority of the approximately 25 percent of Americans who suffer from chronic pain. Chronic pain conditions such as fibromyalgia, chronic fatigue syndrome, endometriosis, and vulvodynia, to name only a few, either disproportionately or solely affect women. Obtaining an accurate diagnosis for such pain can take months or years – and, frustratingly multiple consultations. Even an accurate diagnosis does not lead to relief because few effective treatment options are available.

The reasons for this injustice are many. Health care professionals do not always understand these conditions because of inadequate training. There is not enough scientific research and thus, an alarming lack of effective evidence-based treatments. To add insult to injury, women’s pain reports are not taken as seriously as men and their pain is not treated as aggressively, even though we report pain that is more severe, frequent and of longer duration. We all look forward to the day when this widespread discrimination, neglect, and dismissal of women’s pain will be history, and some little-talked about provisions in the health reform legislation are a step in that direction.

The Patient Protection and Affordable Care Act (ACA) provides hope for chronic pain sufferers that should, according to the American Academy of Pain Medicine, be “applauded.” First, the ACA calls for the Institute of Medicine to convene a Conference on Pain that is meant to: (1) increase awareness of pain as a public health problem; (2) evaluate the adequacy of assessment, diagnosis, treatment, and management of pain; (3) identify barriers to pain care; and (4) establish an agenda for action in both the public and private sectors that will reduce such barriers and improve pain care research. Second, the ACA encourages increased funding for an “aggressive” program of pain research by the National Institutes of Health Pain Consortium. Third, the ACA authorizes the Department of Health and Human Services to fund efforts to educate and train health professionals in pain.

Thus, the ACA addresses the very problems that leave women in pain without answers or hope. Health professionals will receive training to accurately recognize and diagnosis pain conditions. Increased funding for scientific research will lead to new and improved treatment options. And, increased awareness about pain may reduce the stigma women in pain routinely face. We are a long way from righting this incredible wrong, but because of the ACA, we are one step closer.

Edited by Alison Stanton

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Today, the Institute of Medicine published a report on chronic pain in America and ways in which we need to improve treatment of it. You can find it here http://iom.edu/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research.aspx. Jennifer

June 29, 2011 - 9:35am

Anonymous, I thought you were accusing me of being uneducated about the ACA. I didn't realize you were accusing me of being uneducated about chronic pain. Because if I had, I'd have really been offended. I have Crohn's disease and gatroparesis. There's not a single day that goes by -- indeed not an hour -- in which I am not in pain.

Much of what you complain about has NOTHING to do with the health reform law. There were lots of problems with health care before and the law didn't purport to address them all. For example, the health reform law doesn't allow coverage of illegal immigrants, whether or not I think that's a good thing. And nothing in the health reform law stops your GP from continuing to have a small practice -- it's entirely up to him. The economics of health care in America are such that it's harder and harder for solo practitioners, but that trend started way before health reform.

I actually agree with a lot of what you say. I just think you're blaming it on health reform when in fact, what we need is even more regulation of the health care industry. What's crazy to me is that doctors are still making a mint, pharma is making a mint, hospitals are hiring more and more doctors on staff to try to get patients to seek care within the hospital system so they are making a mint. In other countries where health care is more affordable, nobody's getting as rich off the system as people are in the United States. We need incentives for doctors like yours to keep doing what they're doing -- and I know it's harder and harder for them to do so. But that has nothing to do with health reform. Indeed, health reform prizes primary care and patient-centered primary care medical homes.

So I think you and I actually agree about a lot. J

June 27, 2011 - 7:19am
EmpowHER Guest

Not to mention the newly discovered 'glitch' that would qualify about 3 million middle class persons for medicaid. Meaning a married couple could pull in $64,000 a year and receive Medicaid which is already struggling to pay for those who DO equality. Clearly, the APA had 'good' intentions but when you write a bill that long and vote on it before people have had time to process everything there are going to be major screw ups. Same thing that happened with the Patriot Act that so many hate, just vote and we'll figure out what it says later tends not to work longterm All I know is the tricare I now sends me to a hospital that is poorly equipped and below par because I have Prime (the highest/best level). Meanwhile those with tricare standard can go to one of the best hospitals in my city, with top notch doctors and rooms that aren't still dirty from the last patient (literally there was someone else's blood on the floor and sheets when they tried to put me in a room). THIS is what happens when the govn't makes the rules; those who pay more, for the better plan get less. If that's not rationing or causing less equality treatment, then I don't know what is.
The bill needs to be fixed, BADLY. The problem comes down to this; my husband has seen a doctor maybe twice in the last 10 years, he doesn't go to the dr. While he does have healthcare because of me, there is no reason he should HAVE to have healthcare if he's not using it. And unless everyone, including illegals are included in mandatory HC there will still be ppl using the system with no insurance. Supposedly that's what ita all about-- ppl w/o insurance causing HC rates to rise for the rest, but how many millions are here illegally? That's still millions of people w/o HC that will continue to 'cause' prices to rise (and I use the term 'cause' loosely, it's all about $, making $ but this is their claim not mine). Yes we have a duty to help those less fortunate, but overloading the HC system isn't going to help anyone. My GP dr has a small practice, knows his patients stories, families and details about their lives amd medical issues all w/o GLAMCING at a chart. I have his personal email and an emergency cell # that goes straight to him, and him alone. If his patient load suddenly tripled I guarantee that quality of care would cease to exist faster than you can snap your fingers. Toni

June 26, 2011 - 11:09pm
EmpowHER Guest

Ms Jaff- its quite remarkable to say you are educated about pain because you read the PPACA-an act that would have excluded issues on pain if it werent for the efforts of Senator Hatch and the APF. I recommend you read A Call To Revolutionize Pain Care In America, HUman Rights Watches Report- Please Dont Make Us Suffer Anymore-and The Overlapping Conditions Alliance 2010 report on pain. As someone who knows something about pain care-the efforts of the Federal government from the PPACa- reflect the continuous escalation of failure of the government to take the suffering of millions of Americans seriously-and pain will remain "tragically overlooked" as the aforementioned reports mention- or as the Texas Pain Inititatives 2007 rep[ort indicated- the massive failure to assess and treat pan will continue when folks like yourself and folks in government take the issue seriously- You are not on the right side because you fail to do much investigating and hence your glib attitude toward people in pain and those who care about them
- IF Doctors were trained then theyd realize pain should be taken seriously and they would band together to improve pain care

June 26, 2011 - 9:59am

Oh, and to the other Anonymous, you can disagree with me, but don't destroy your own credibility by saying I'm uneducated. I've read every word of the ACA and most of the regulations that have been promulgated thereunder (I have not read the regulations on health IT).

I don't understand why you, who seem to have a passion for advocating on behalf of chronic pain patients, would attack a piece on the need to do more to address chronic pain. I gave you two examples of things in the ACA that are aimed at addressing chronic pain -- but I never said that was good enough, and the article as a whole is intended to support those -- especially women -- with chronic pain. I hear at least once a week from a patient who went to the ER in agony and was turned away because of the bias that they are drug seeking. I was with a doctor last night who told me a story of a patient who was in agony from active Crohn's disease. She overheard a resident telling him to go home and she intervened and made it clear that the man was in agony for a reason, that he needed to be checked to see if he had an intestinal obstruction, and that the resident was wrong to jump to the conclusion that the patient was a drug seeker.

I'm firmly on the side of people with chronic pain who are not getting adequate care. But the issue is more complicated than just training doctors. Washington State passed a law that goes into effect this month that says that no doctor can prescribe opiates without consulting with a pain specialist. So loads of chronic pain patients are being told their doctors can't write their prescriptions any more. This is a HUGE problem -- and I am acutely aware of it because, at my sickest, I was in complete agony for about 3 years, and I had to beg and plead for anything stronger than Tylenol.

I do not believe the ACA is the answer to all that. I do think the steps that are taken in the ACA are positive steps. But they are not enough.

But bottom line is I'm totally on your side. To the extent that you read my piece to imply otherwise, I'm sure that is due to my imperfection in drafting. I hope that I have cleared that up now. Jennifer

June 17, 2011 - 4:59am
EmpowHER Guest

So Think Progress is a reliable source? According to it's own website Think Progress is a project of the Center for American Progress Action Fund. The Center for American Progress Action Fund is a nonpartisan organization. Through this blog, CAPAF seeks to provide a forum that ****advances progressive ideas and policies.**** http://thinkprogress.org/about/
ThinkProgress was voted **“Best Liberal Blog”*** in the 2006 Weblog Awards. That hardly makes it nonpartisan or neutral, if the McKinsey report is flawed then so is the ThinkProgress report; I'm not sure who was arguing that fibro. wasnt a recognized disease, no one stipulated that anywhere I could see. Perhaps a post was deleted?
K in Dallas

June 17, 2011 - 12:58am
(reply to Anonymous)

Other sources: http://thehill.com/blogs/healthwatch/politics-elections/166889-baucus-demands-answers-on-consultants-controversial-healthcare-reform-study- Senator Baucus has critiqued the McKinsey report saying it conflicts with reports of other "reputable, transparent" reports on the same subject. He's asked that the authors of the report disclose their methodology so the veracity and reliability of the report could be evaluated. So a conservative Democrat who did more to narrow the scope of health reform than perhaps any other member of the Senate doesn't believe this report either. Jennifer

June 17, 2011 - 4:48am

That report that said that 30% of employers will drop coverage? First, that was put out by the McKinsey group -- not exactly neutral. Second, that has nothing to do with the individual mandate; it has to to with the LACK of an employer mandate. Third, that study is widely criticized . http://thinkprogress.org/health/2011/06/07/238382/if-youre-concerned-about-employers-dropping-coverage-advocate-for-the-employer-mandate/. And the Obama administration is trying to stop it from happening. http://thehill.com/business-a-lobbying/103131-white-house-unveils-rules.

I'm not sure if it's the same Anonymous posting about Chronic Fatigue, but we do many disability appeals for chronic fatigue and you are certainly correct. Jennifer

June 13, 2011 - 4:48am
EmpowHER Guest

Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) is recognized by the National Institute of Health (NIH), Centers for Disease Control (CDC), Food and Drug Administration (FDA) and Social Security Administration (SSA) as a serious, often disabling illness. Chronic Fatigue Syndrome is marked by unrelenting exhaustion, muscle pain, cognitive disorders that patients call "brain fog," and a myriad of other physical symptoms.


June 12, 2011 - 11:11pm

With all due respect, I don't think you've read the ACA or you'd know that most of what you say is not true. There is no care rationing; that's pure scare-tactics that comes from anti-reformers. Insurance and health care already are very regulated; the ACA just changes some of those regulations, with the major health care changes occurring in Medicaid and Medicare, which are creatures of federal law and based 100% on government regulation. And in light of the Congressional earmark ban, you should see the reduction of "pet projects," but certainly, there are no such "projects" in the ACA. Since I've read the entire law and all of the regulations that have been issued to implement it, I would suggest that my information may be a little more accurate than the dogmatic, baseless critiques you've been hearing. The biggest mistake the Dems made around health reform is this failure of messaging, allowing opponents to repeat allegations like the ones you make with impunity.

I will have another piece coming soon on the provisions of the ACA that are of particular help to women. I hope you will read it with an open mind. Jennifer

June 10, 2011 - 6:29am
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