CMScript 8 of 2024: Understanding and managing pain
Pain, both acute and chronic, impacts billions of people globally and is generally a primary reason for seeking healthcare. Essentially, pain involves a complex interaction among nerves, the spinal cord, and the brain. It is a significant public health issue regardless of its form or severity. Pain contributes to illness, mortality, and potentially disabling conditions within the economically active population. Additionally, it places a substantial strain on healthcare systems due to treatment limitations and constrained financial resources.
What is Pain?
Pain is difficult to understand due to its subjective nature and varies based on individual experiences and perceptions. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is experienced as physical, emotional, psychosocial, cultural, and spiritual and all these aspects of a person’s life need to be addressed to relieve pain and suffering. Everyone experiences pain differently, so understanding the various types of pain can help patients communicate their symptoms more effectively to healthcare providers.
The most common types of pain are:
Acute pain
Acute pain is short-term, typically lasting from minutes to three months, and in some cases, it can extend up to six months. It is often linked to causes such as soft-tissue injuries (like cuts, sprains), or broken bones, or temporary illnesses (such as infections or surgical procedures).
Acute pain usually resolves once the injury heals or the illness passes. However, if an injury fails to heal properly, acute pain may progress into chronic pain.
Chronic pain
Chronic pain persists for an extended period (more than three months) and can be constant or intermittent, such as headaches that recur over months or years. Chronic pain is considered both a disease and a significant healthcare issue, often leading to intense suffering and diminished quality of life. It may stem from chronic diseases like arthritis, fibromyalgia, or neuropathic conditions requiring specific diagnosis and treatment. However, the cause of chronic pain is unknown in many cases.
What is covered under the Prescribed Minimum Benefit (PMB) level of care in pain management?
When a member is diagnosed with a PMB condition where pain management is needed, pharmacological treatment forms a significant component of pain therapy.
Medical schemes must pay for in and out-of-hospital costs in full if the services were obtained from a designated service provider (DSP). The healthcare practitioner must assist the member in completing the forms to register for PMB benefits which must be funded by the medical scheme from the risk benefit.
For more information on pain management and coverage, download full CMScript here.
