In America today, we face many challenging issues in the delivery of quality health care. These issues have been further clouded with recent passage of health care reform legislation. This brief dissertation serves to call your attention to but one challenge, chronic pain in women's health. It is a nonrelenting challenge that deserves our full attention, dedication and perseverance. Emily Dickinson, the American poet, once wrote:
“We never know how high we are
Till we are called to rise;
And then, if we are true to plan,
Our statures touch the skies.”
A national organization, The Overlapping Conditions Alliance, states that “millions of Americans suffer from chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, temporomandibular joint and muscle disorders, and vulvodynia.” Many of these chronic pain conditions may overlap or coexist. Perhaps some are poorly understood, hence health care providers may receive inadequate formal training in these disorders, and some patients may be misdiagnosed or receive inappropriate treatment. Research on the overlap of these conditions is in its infancy, so we don't know how or WHY they coexist. We do know that some patients may suffer from two or more conditions at the same time or may suffer from one condition for many years before developing a second or third. While some of these conditions are specific to women, others have a strong affinity for women, but we do not know WHY. The cost of these conditions to the United States each year can be measured in tens of billions of dollars in expense and lost productivity. “An expanded federal research effort is urgently needed to investigate common mechanisms and risk factors for these disorders, so that preventive strategies and more effective treatments can be developed.”
In Washington D.C., on May 19, 2010, the Overlap-ping Conditions Alliance, in cooperation with the U.S. Congressional Caucus for Women’s Issues, launched a campaign to end chronic pain in women. The campaign is attempting to end perceived discrimination and to improve care for women suffering from chronic pain. The campaign has the goal of improving the quality of women’s lives by raising awareness about chronic pain conditions that disproportionately impact women and to address the neglect, dismissal, and discrimination faced by women living with chronic pain under the current U.S. health care system. “While health care reform legislation took an important first step to address chronic pain issues, we have a lot of work ahead of us,” said a representative for Caucus Co-Chair Representative Tammy Baldwin (D-WI).
The campaign made public its groundbreaking report : Chronic Pain in Women: Neglect, Dismissal and Discrimination, which “examines current lack of effective treatments and research funding for chronic pain conditions that predominately affect women, and how improvements in research, education and access to effective treatments could contribute to improved quality of care and cost control.” The report states that “in 2009 the National Institutes of Health invested only sixty-five million dollars in research into the six chronic pain conditions highlighted in the report—chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, temporomandibular (TMJ) disorders and vulvodynia—just two-tenths of one percent of its total budget. That is an average of just $1.33 for every affected woman and represents less than one-tenth of one percent of the annual estimated cost of these conditions.”
Temporomandibular (TMJ) disorders were represented at this meeting by the TMJ Association, an organization founded in August 1986 in Wisconsin by two people who had temporomandibular joint disease. To date, the TMJ Association continues as a consumer-based organization that holds meetings “with hopes of finding solutions to the problems that compromised the quality of their lives.” Most of us may agree that consumer advocacy groups are very important to the discovery and institution of successful treatment formats based on valid scientific information. However, it is unfortunate that the Alliance of TMD Organizations was not invited to participate in this historic meeting to offer a much broader view of education, research, and treatment in the field of temporomandibular disorders and craniofacial pain. It is misleading for a consumer-based TMJ group to be the sole public representative of the field of TMD. I am aware that the Alliance has expended great effort to communicate and educate the public and members of Congress but exclusion from this meeting indicates that even more must be done for the Alliance to be publicly recognized as the authority in matters relating to TMD diagnosis, treatment, and research.
Those who treat craniofacial pain patients have long recognized that craniofacial pain often presents itself differently in women than in men, and treatment modalities are prescribed accordingly, so discrimination is not a reality. This is not necessarily true in the field of medicine. For example, Dr. Richard Fogoros, on the about.com website, reports two common misapprehensions, regarding heart disease, held by both women and often by their physicians. “Women really don’t get heart disease, and when they do, it behaves pretty much like the heart disease that men get.” While heart disease is the number one killer of women (513,000 deaths in 1999), 6 in 10 women, according to the American Heart Association, said that the major threat to their health was breast cancer. Our field leads the way in recognition of craniofacial pain as a major women’s health issue. It is well recognized that 85% of the patients who seek professional intervention for TMD or craniofacial pain are women. However, at this time we do not have a scientific basis for WHY craniofacial pain disproportionately affects women. Is it because of anatomic, genetic, neurologic, hormonal, or psychologic differences that women have a much greater occurrence of craniofacial pain than men?
It is critical for the American Alliance of TMD Organizations to maximize it’s efforts to publicly establish itself as the leadership organization for TMD and craniofacial pain research, education, and patient care. The Alliance must strongly exhibit consistent dedication and determination in working with educational and research institutions, the leadership in women’s health issues and with professional, governmental, and private organizations. And finally, the Alliance has the responsibility to aggressively seek answers to vital questions regarding TMD and craniofacial pain as a major debilitating women’s health issue. WHY? That is the question.
Beverly Sills, former American opera soprano, said, “You may be disappointed if you fail, but doomed if you don’t try.”
William F. Slagle, D.D.S.
Seminole Oklahoma
wfs2@sbcglobal.net
© 2009-2012: The Journal of Craniomandibular Practice. Site by Medium