The problem of chronic pain -- one of the biggest financial and time drains on Detroit's emergency rooms -- is worsening as fewer people have health insurance to treat the problem before it becomes extreme.
Chronic pain affects three times as many people as heart disease and costs the nation as much as obesity, yet Detroit and some suburban emergency rooms often fail to effectively treat chronic pain.
"It's a constant frustration for both sides and there's no good answer," said Gerald Fitzgerald, president and chief executive officer of the Dearborn-based Oakwood Health System.
More than 50 million Americans suffer from chronic pain, costing more than $120 billion in reduced productivity, sick time and medical costs, the American Chronic Pain Association and the National Institutes of Health estimate.
As Americans live longer, they're more likely to suffer from painful, chronic conditions such as arthritis and diabetes.
Metro Detroit hospitals are aware of the problem and are taking preventive steps, from requiring hospital staffs to measure patients' pain more frequently to making drugs more readily available. An Upper Peninsula hospital is creating a pain network to help streamline care for patients; a doctor recently opened a clinic in West Bloomfield specifically aimed at treating pain.
But the problem is especially pronounced in Detroit, where large numbers of poor and uninsured, along with already overburdened emergency rooms, overwhelm the system. Doctors say patients who return to the ER repeatedly seeking help for pain are the biggest drain on their time and resources. Patients complain they are ignored or undertreated for debilitating symptoms.
"Pain is the No. 1 reason people visit their physicians, yet many physicians don't receive much training in how to handle pain," said Dr. Carmen Green, director of pain research at the University of Michigan.
A number of factors exacerbate the problem in the emergency room:
Lack of training on how to handle pain is a major contributor.
Patients who go to the ER for the first line of treatment are often poor and uninsured and not getting regular care.
Many are women and minorities, two groups that many studies indicate often receive less adequate treatment for pain.
"There's an intersection of all these vulnerable populations that creates a situation where people don't get very good treatment," Green said.