Macroeconomic impact of chronic pain

Investment Analysis Clubs Macro Economic Trends and Risks
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Chronic pain is the leading cause of disability in America. An estimated 50 million adults in the United States experienced chronic pain (i.e., pain lasting ≥3 months) in 2016, resulting in substantial health care costs and lost productivity. During 2021, an estimated 20.9% of U.S. adults (51.6 million persons) experienced chronic pain, and 6.9% (17.1 million persons) experienced high-impact chronic pain (i.e., chronic pain that results in substantial restriction to daily activities).

Chronic pain (i.e., pain lasting ≥3 months) is a debilitating condition that affects daily work and life activities for many adults in the United States and has been linked with depression, Alzheimer disease and related dementias, higher suicide risk, and substance use and misuse.

Chronic pain has Macroeconomic impact by reducing productivity and increasing medical costs.

The opioid crisis was largely caused by the false claim that opioids such as oxycontin did not have the same addictive potential of other opioids (such as morphine). To reduce the addiction of chronic pain patients doctors were advised to cut off the supply of opioids. This left many patients in agony. Some turned to heroin and died of overdose.

There’s a huge need for drugs to address chronic pain. Some doctors are prescribing Gabapentin (Neurontin) off-label for chronic pain. Gabapentin is approved for seizures and post-herpetic neuralgia; gabapentin enacarbil is approved for restless legs syndrome. Despite limited indications, gabapentin and its cousin, pregabalin (Lyrica), are widely prescribed off-label (https://www.medpagetoday.com/neurology/generalneurology/108370) for various other pain syndromes.

A large new study (n = 52,000) shows that dementia risk was more than double and mild cognitive impairment risk more than triple among those ages 35 to 49 in chronic back pain patients who used gabapentin for a long time. A similar pattern emerged among those 50 to 64 years old.

Gabapentin’s clinical trials were performed for it prescribed uses. This shows the problem of using drugs off-label – there’s no data unless someone decides to research it on their own using medical records. There’s no long-term data even for on-label drugs since FDA approval relies on clinical trials that last a short time.

There’s clearly a need for non-addictive drugs for chronic pain.

Journavx is the first new kind of painkiller in more than 20 years, and the medical community is cautiously optimistic that Journavx (manufactured by Vertex Pharmaceuticals) doesn’t have the same addictive potential as opioids do.

But the new pills are expensive, and not everyone has been able to access them, thanks to a narrowly-focused FDA approval and limited insurance coverage.

https://www.npr.org/sections/shots-health-news/2025/07/10/nx-s1-5463569/opioid-alternative-painkiller-journavx-acute-pain-fda-approval

On Jan. 30, 2025 Vertex Pharmaceuticals Incorporated (Nasdaq: VRTX) announced that the U.S. Food and Drug Administration (FDA) has approved JOURNAVX™ (suzetrigine), an oral, non-opioid, highly selective NaV1.8 pain signal inhibitor for the treatment of adults with moderate-to-severe acute pain. Acute pain is a serious and potentially disabling condition often caused by surgery, accident or injury. Over 80 million Americans are prescribed medicine to treat their moderate-to-severe acute pain every year.

Studies are now underway that could help Journavx win additional FDA approvals for some kinds of chronic pain. Vertex says it is specifically studying Journavx in patients with diabetic peripheral neuropathy, painful nerve damage in the limbs, and lumbosacral radiculopathy, a type of low-back pain caused by a pinched nerve.

But approval will take a while. There’s a big difference between taking a pain killer for a couple of weeks for acute pain and taking it potentially for life for chronic pain.

https://news.vrtx.com/news-releases/news-release-details/vertex-announces-fda-approval-journavxtm-suzetrigine-first-class

The U.S. Food and Drug Administration approved twice-daily JOURNAVX for the treatment of adults with moderate-to-severe acute pain. Vertex has established a wholesale acquisition cost for JOURNAVX in the United States of $15.50 per 50mg pill.

Wow! That’s super expensive! Since this is a brand-new drug there won’t be any generic equivalents. If JOURNAVX is approved for chronic pain it could become a blockbuster for Vertex and a burden on insurers.

Wendy

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I do not know how long Journavx has been on the market.

Conservative medicine when possible is best. Meaning on the market for five years to see if the drug is pulled from the market. People can get very badly hurt by drugs that will be pulled later.

That is an important medical principle.

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It’s also faulty reasoning. If every prescriber sat around waiting for 5 years to see if any new side effects cropped up, then no one would be taking the drug…so you’d end up waiting another 5 years, and so on…

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I thought the easy availability of Oxycontin and Fentanyl was supposed to take care of that?

intercst

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Oh man. I have been taking 500mg of Gabapentin to help sleep for the last year and a half.

Well, back to the drawing board.

Sleep doctor who prescribed it had me get off Trazadone for the same reason.

Guess I’ll make sure I do what used to work in my earlier years: major leg muscle stretches.

I am glad you posted this.

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And I am glad that you posted your post. Thnx.

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These opioids used to be easily available for chronic pain but not anymore. For acute pain, such as post-surgery for a few weeks, yes. But for chronic pain, no.

Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient.

Wendy

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You do not have to worry about that at all. Almost no doctors wait around 5 years based on this principle. Instead, most doctors buy into the hype on pharma and poison their patients. Go for it. Prove your point. Your problems will be horrible.

Your lack of caring is what most doctors practice. At least eat your own cooking. Seriously it is lack of knowledge until the drug is pulled. Odds are something like like 67% the drug will be pulled after doing damage or leaving people with chronic disease and ineffective care.

Odds are the hype was faulty theorizing and the drug will be pulled after doing horrendous damage to patients.

+++++++++++++++

Don’t rely on Google AI for this. Delusional information bought and paid for by pharma. When Google AI says 4.25% are pulled that is out of 100% of new chemicals(this bit is not stated), but out of 100% only something like 6% of drugs make it to market in the first place. In other words 6% minus 4.25%…AI cheatware? No way. Way?

Instead take a gander at this.

FDA Drug Recall Statistics [Updated For 2024].

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VeeEnn,

20 years ago I was hanging out in a bar totally sober but hanging out with the guys hoping to meet a young woman.

My barber drunk on his barstool was making a bet with the local bookie each time a batter got up to bat during a ball game we were watching. The bet was that the hitter would get on base. It is something like 1/3 of hitters get on base. After losing $20 bets of $1 the bookie suddenly realized the odds of winning.

Need I say the odds of getting a better drug are like that $*cker bet. Doctors make that bet every day.

++++++++++++++++++

I have a friend over coffee who does not get my ideas on medicine. He is a retired medical salesman who managed the other salesmen and women in a large territory. He insists on statical data to back everything up. By law in his field of sales without that data you were putting your neck on the line.

He does not have a clue how a doctor would disregard that data and practice medicine. The number one way is not take $*cker bets with hyped up new theorizing that is really a complete lack of knowledge.

My friend is a multimillionaire based on that hyped up theorizing. He has never known whether it had any value or not. Most of it was thrown out later.

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I see you typing.

How did my dad practice medicine then? You might ask.

There are plenty of drugs on the market for most things. Most major disease.

Pain management is a very tough one. It will be hard for chronic pain suffers to hold out. It is a very difficult situation.

Psychiatric practice managing pain was different. People had pain and anxiety. Dad had to guard people from painkillers for his entire career. He also had to guard them from minor tranquilizers.

Probably why he did not entertain $*cker bets.

People suffered. He could not stop that but he could help. He could help with other drugs and talk begin to work on their problems.

When new drugs were introduced for chronic illness he would wait the five years. Many of the new drugs turned out to be dangerous. The older drugs were often better.

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[quote=“WendyBG, post:7, topic:119816, full:true”]

Well, I for one am thankful that both dh’s cardiothoracic surgeon and my orthopedist were confident of the degree of post op pain likely for our respective procedures…and didn’t shilly shally around with any nonnpharmacologic remedies. Probably something to do with understanding pharmacology…and the minimal risk of creating an addict from appropriately prescribed opioids.

It’s a noble gesture to try to prevent the misuse of addictive pharmaceuticals but the wrong victims are now being targeted in the War on Drugs…i.e. those folk whose prescriptions are obtained legitimately. A campaign that reads well but unfortunately, it creates the image that opioid use is synonymous with illicit drug abuse in the eyes of the general public.

I believe I’ve mentioned this before but, during husband’s post op period, I stayed in his room with a couple of trips home (barely 20 miles) to check on things. The elevators in the hospital all had something based on this campaign plastered inside the doors. #1 on the list was “ask your doctor for an alternative to opioid pain meds” or words to that effect … even on the express car to the cardiothoracic ICU!! Stuck in my craw somewhat as, on the first couple of nights, 2.30 am we…and the overnight nurses …were woken by his alarms screaming. He’d slept through the 2 am pill taking time (faulty nursing practices to just leave his pills for if he needed them), obviously started breathing more shallowly in his sleep as the analgesia wore off…and triggered Afib as his oxygen saturation dropped. I made sure we didn’t have THAT happen again.

I was around and prescribing…and using… in the early years when a previous new type of pain med was introduced in the UK…NSAIDS. Specifically ibuprofen. I found it a useful addition to the tylenol/opioid combo after I developed a dry socket following 3rd molar surgery. I needed a prescription for the NSAID…the Vicodin type meds were available OTC.

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@VeeEnn I agree with you…but…

There is more nuance to this issue.

The topic is chronic pain, not acute post-operative pain as in the case of your husband.

On the one hand, you have people like my younger sister who is in constant pain from severe scoliosis. She is very aware of the problem of potential addiction and wants to use tramadol (a mild opioid) intermittently for occasions when she will be walking a distance. But none of her doctors will prescribe it for her. This doesn’t make sense because she is able to use it responsibly and not become addicted.

On the other hand, the statistics show many opioid overdoses of elderly people (in my local area) during the years before the clampdown on opioid prescribing. Once the opioids were withdrawn the overdose case load shifted to young people (street addicts with illegal drugs).

This is a fraught issue because people in chronic pain may get heroin from the street and die of an overdose. (My sister knows one personally.)

I personally took an opioid (hydrocodone) for months after my bilateral mastectomy because the expanders implanted under my pectoral muscles were so painful. This was in 2015 before the clamp-down on opioids. My experience is that if it’s still painful even with the opioids I won’t get addicted. The danger zone is when the pain goes away. But many people aren’t willing to tolerate pain and go over the line.

Some may be genetically more prone to addiction and the doctor can’t determine in advance.

Wendy

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Tragically, it is not that straightforward. People have gone on opioids for proper medical reasons and become full-blown addicts very quickly. Many have died as a result. There is no testing beforehand to distinguish between those who will benefit and those who will get into major trouble.

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It was approved in January, six months ago.

DB2
Long VRTX

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Whilst I don’t doubt the reality of different genetic responses, it’s good to also realise that there appears to be a different response depending on whether opioids are prescribed appropriately for pain management or whether they’re taken for recreational purposes.

I did my foundational pharmacology and associated pain management course back in the early 1970s. Almost predating the identication of the first mu receptors…but the existence was known. Now, we had quite a few lectures from clinicians on how to identify drug seeking behaviors…not surprising in a way as my/dh’s alma mater had the largest methadone treatment center in the UK so I guess you could say there was a lot of it about. Anyway, amid all the scary talk we had a youngish guy who was actually either a PhD candidate or a post doc whose area of study happened to be these areas of the brain…and he introduced the idea that indeed, the recreational use folk with no pain actually did respond differently. So, there’s that.

Problem is, the narrative that’s so frequently read…and presumably supported by various interest groups…tends to be from the recreational users/opioid addicted point of view and, sorry to sound judgemental (not sorry), this is likely to have a whole heap of self justification in the stories told. Just before we moved out to Colorado 2016, our local NPR station had a week long feature on the impact of opioid abuse/addiction on families etc. Every story was more tragic than the one before …gripping listening as it was a tale of young lives destroyed. Here’s the thing, not only were none of the stories related to legitimately prescribed meds for pain management, they weren’t the first drug ofvabuse. Ethanol being a popular gateway drug.

Tramadol was another development intended to provide pain management with a lower addiction potential as it targeted a different mu receptor series than oxy etc. No such thing as a good idea that is immune to misuse. It also doesn’t give the same response that addicts crave at recommended dosage so,what’s a druggie to do? Why, you take even more to achieve the desired effect. This is why your sister cannot readily get a prescription. It becameca controlled substance about a decade ago (per my daughter)

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had a blowout leg injury back in '05. When it happened, there was intense pain, but it went away as long as leg wasn’t used, and believe me, I wasn’t about to use it,lol. Took 2 weeks before doctor could do surgery. After waking up from it, they gave me vicodin, and a prescription for it. Felt no pain, until the vicodin wore off, then had some of the most intense pain I’ve ever felt, from the surgery after effects. Got that prescription filled, and all was good again. Went thru half the bottle ( don’t remember how many days worth, probably at least 2 weeks of taking the drug ). Even then, I had read about the danger of how addictive vicodin was, so I was determined to wean myself off of it as soon as possible. Did not have any problems, just quit taking them and the pain had tamped down enough that it was fairly easy to quit using them.

Funny part was a few people that I knew, they were aware that I had half a bottle of vicodin that I wasn’t going to use, and they wanted them, intensely. I don’t remember how I disposed of them, but I did not sell them or give them away.
The people asking for them had chronic back pain, so it’s likely they had been taking powerful painkillers for quite some time. One guy, half kiddingly, called me a @#$%#$# boy scout for not giving them up, lol. But there was no way I was going to be risking giving away a powerful drug to somebody, with the possibility ( maybe remote, but didn’t care ) of them od’ing on them.

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79k Americans died in 2023 from opioid abuse. Anyone who touches them rolls a dice about abusing them. Does not matter how great they think they are when they look in the mirror.

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In reality, @UpNorthJoe …your story is probably the experience of a good many folk using opioids… you just never hear about such ordinary stories as they’re not newsworthy. My lapiplasties were similar…beyond me understanding the concept of “staying ahead of the pain” (taking the meds on prescribed schedule since waiting to see if you really needed them will probably have you REALLY needing them … seems you know what I’m talking about!) Also, for me, I couldn’t wait to actually not need them…not for fear of addiction, but rather I couldn’t stand the nausea, constipation, and that feeling of being a bit “one step behind”. That’s my best description…certainly not what I’d call euphoria or anything that would drive me to criminal behaviour to achieve (getting rid of pain is another matter!!)

My take is, if I am unwilling/unable to tolerate moderate to severe pain over the short term, it’s a bit nervy of me to expect others to do just that over the long haul.

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Precisely!! Abuse is the problem.

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I feel the same way. One of my personality traits is that I try to not judge other people when I don’t know what they’re going thru. I clearly remember what it felt like when that 1st dose wore off after surgery, was like a caged animal, what have done darn near anything to make that pain go away. And I agree about the sluggishness and nauseousness while on the pain killer, that was probably more of a deterrent to keep taking them than fear of addiction.

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