Malpractice lawsuits related to chronic pain management have increased significantly over the past thirty years, according to a recent report presented at the American Society of Anesthesiologists 2014 Annual Meeting. The number of people qualified as pain management specialists (anesthesiologists) has also increased, but not enough to meet the needs of a growing group of patients with constant pain.
This latest report looked at malpractice lawsuits, many of which involved permanent disabling injury or death, and found that not only has the number of claims risen since 1980, the severity of the damages has also increased. Presenting the findings at the meeting, Dr. Kelly Pollack of the University of Washington and the Seattle Cancer Care Alliance, noted that pain specialists are using more powerful analgesics and interventions and need to be acutely aware of the potential for severe adverse effects.
Modern Pain Management Problems
Opioid medication use has increased, bringing with it issues such as addiction and overdose, and patients are also increasingly receiving injections in the cervical spine which can cause both acute and long-term side effects, including decreased bone density and increased pain. A significant number of medical malpractice claims involved epidural steroid injections in the lumbar spine in 1980, but more recently these lawsuits tend to detail death from accidental overdoses and serious nerve injuries related to pain management interventions.
In fact, claims based on medication management went from accounting for 2% of claims in 1980 to 17% in 2012. Claims related to cervical neuraxial injections went from 16% to 27%, and claims to do with the implantation, removal and maintenance of devices related to pain management went from 3% to 16%. Conversely, malpractice suits related to lumbar steroid injections decreased from accounting for 37% of claims to just 17%.
Such trends may seem somewhat predictable, given the increase in strategies for pain management since the 1980s, where epidural steroids were the main treatment choice for back pain and neck pain.
More Pain Management Specialists – But also More Deaths
The number of pain management specialists was found to increase by 2% every ten years, while pain-related malpractice suits increased by 6.3% in ten years, meaning that an increase in the sheer numbers of people seeing pain management specialists was not the sole reason for the increase in claims. In total, the researchers looked at 10,367 anesthesia malpractice claims entered into the Anesthesia Closed Claims Project Database, with 1037 of these related to chronic pain management and the remaining 8545 related to surgical, obstetric, and acute pain.
Complications related to chronic pain increased significantly from 1980 to 2012, and there was an increase from 3% to 18% for the proportion of anesthesia claims related to chronic pain managements. Worryingly, after 2000, the number of chronic pain claims related to death and severe nerve injury rose from 6% in both cases to 19% and 28%. It appears that minor problems decreased, so when something went wrong it went really wrong with pain management.
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American Society of Anesthesiologists (ASA) 2014 Annual Meeting: Abstract BOC02. Presented October 14, 2014.