How much is your pain worth?

I was reading the news about a new drug that came on the market. It is called suzetrigine, which apparently is the first drug FDA has approved in 25 years. What caught my attention was not the drug. Because it probably will take a long while before we start seeing it in Singapore.

I also have reservations about how well it will work. Because pain is inherently complex and multifactorial. It will take years, or even decades, more of research before we can conclusive tell if it does or does not work.

What did catch my attention was it’s price. It’s freaking $15.50 USD or freaking $21 SGD per dose. Given that it’s meant to be drug that is taken every 12-hour. That is $45 per day, assuming if it works.

So that got me thinking. How much is your pain worth?

Cost of chiropractic in Singapore

There is research to show that chiropractic is cost-effective in the longer term. A study published last year found that pain patients who saw a chiropractor first spent significantly less money in healthcare costs compared to those who did not.

Previously we discussed how the cost of chiropractic in Singapore is between $80 to $120. In my opinion, this still largely stands. Singapore Pain Solutions or Re:Chiro charges $80 for consultation without treatment, and $100 with treatment. Vitality Chiropractic charges $130, Healing Hands Chiropractic charges $150.42. You get the drift.

It’s possible that healthcare cost for chiropractic patients in Singapore is cheaper than mainstream medical care if we compare it to private practice. However, if we want to compare chiropractic  fees to public health spending for chronic pain, it’s extremely improbable that chiropractic will be ever cheaper than public health.

This is honestly great news for Singaporeans. If we are willing to choose public health, we can save a lot of money. Affordability also doesn’t mean poor quality. Singapore healthcare is world-class and one of the best in the world!

Chiropractic fees in Singapore vs. public health

The cost of a polyclinic consultation at SingHealth Polyclinics is only $17.50 today. Even if we look at specialist care, the initial consultation fee is $76.25 while follow ups range from $30.50 to $71.17.

This is ridiculously low compared to the average genereal practitioner fee of $137 in the United States. The highest reported consultation fee was $872! As Singaporeans, I don’t think we can fully appreciate the economic burden of chronic pain on the average American.

Living in Singapore is indeed a blessing.

Public health fees in Singapore is heavily subsidised. The truth of the matter is that choosing public health will inevitable be the cheapest treatment option. There is no way seeing a chiropractor (or private physiotherapist) can ever be cheaper than public health in Singapore.

Downside of public health from chronic pain

To be clear, I am 100% pro public health. Singapore General Hospital at some point is ranked 4th in the world, why would it not be good enough for me? Personally, I do utilise public health for my own healthcare needs. Nonetheless, I can understand not everyone likes the public health system, and that’s fair.

Public health is not for everyone. While cost is low, waiting times can be long. Especially if your condition is not deemed to be urgent by the referring doctor. Getting more frequent treatments may also be challenging. Most physiotherapy follow ups seems to range around two to four or five weeks, lower than what many of my clients would prefer.

Poor customer service from healthcare providers?

There are also a lot of complaints about the bedside manners of doctors in Singapore. That is usually what I hear from my clients who decide to switch from public health to seeing me. Whether we like it or not, public healthcare workers are overworked. And there is significant strain on the public polyclinics and hospitals.

A newspaper article published last year reported that 20% of junior doctors may work more than 80 hours a week. Can you imagine that?

While Singapore Ministry of Manpower’s guide to full-time work in Singapore is 44 hours, Medical Council’s guidelines provide for junior doctors to work up to 80 hours per week. Being a doctor is no easy feat. No wonder burnout rate among doctors is an issue in Singapore.

If we come to appreciate that, we may extend more grace to our healthcare workers. The problem may be our unfound expectations rather than their ability to provide good medical care. I personally don’t feel that doctors in Singapore have poor bedside manners.

Doctors serves a purpose in healthcare, and making us happy shouldn’t be a big part of their job.

“Cost” of chronic comes in more than monetary forms

So far we have been discussing cost of chronic pain in dollars and cents. As with my earlier question, how much is your pain worth to you?

Are you suffering enough to do something about it?

We have established that you can do so something about it for as little as $17.50. Maybe your case is more serious and need specialist care, and that would work out to $17.50 (for specialist referral) plus $76.25 for specialist initial consultation. While I get $93.75 is far from pocket change, it is definitely not beyond the means of the average Singaporean.

Yet one in three Singaporeans choose to ignore their pain with  almost two-thirds choosing to self-diagnose their pain.

Suffering is also a cost

I always encourage people to seek care early, especially if you are going down the polyclinic and public hospital route. You cannot get an immediate specialist or physiotherapy appointment under the subsidised rate. If you choose to wait till you tak boleh tahan (i.e., cannot take it), you will be suffering a lot more!

This is usually when people start complaining about not being able to get an appointment. In my opinion, this is a case of optimism bias. As humans, we tend to think “not me, not now” so we don’t take action. Because we choose to delay a small, inconsequential pain, it can potentially blow up to become a much bigger issue.

The end result is having to wait for a much needed appointment either with a specialist or a physiotherapist. You literally suffer more pain while you wait. The impatience of waiting adds another dimension to your suffer. It’s a lose-lose.

Remember, you can always get a referral first then later cancel or reschedule if you don’t feel like you need the appointment. To be kind to others, please reschedule early so the slot can go to someone else who needs it more than you. Remember, our  public healthcare is strained and our healthcare providers, to some extent, are suffering.

We can be kind.

Time as a cost

By choosing to delay treatment, you also waste more time. I don’t mean waste time in terms of waiting for a doctor’s appointment. Time wastage also comes in that it takes you longer to complete a task than you usually would.

It could be literal. For example, it takes you longer to put on your shoes because of your back pain. Perhaps you now need to sit down. That’s a couple of seconds, twice a day, multiply by however long it takes for your back pain to gets away. It does add up.

Sure, it’s only seconds and minutes you say.

What about the extra naps or bed rest you need to take because your pain is insufferable? They certainly are disruptive. It takes time away from what doing what you love, what you need to do, whatever it is.

Some has described chronic pain as a mental “background noise”. Sometimes it’s just there. Sometimes it’s overwhelming and can lead to fatigue or feelings of helplessness or hopelessness. You may start to worry more. You may find yourself procrastinating more cos it’s harder to get down to doing what you need to do, etc.

All of these have time as a cost.

How much are you willing to spend today for freedom from pain?

First, we have to appreciate and acknowledge that everyone has different pain threshold and pain tolerance. For some people, it doesn’t take much pain for them to seek treatment. For others, they would never seek treatment for their physical (or emotional) pain for their entire lives!

There is no right or wrong. You do you.

The more you want your pain to go away, the more money you are willing to spend. Vertex Pharmaceuticals, the manufacturer of suzetrigine, is banking on that Americans are willing to spend $45 per day to make their pain improve. Based on what I read so far, suzetrigine doesn’t completely eradicate pain but does provide some pain relief.

I don’t think Singaporeans will buy into that. $21 for a painkiller, in my opinion, is more than what Singaporeans are willing to pay for a painkiller. I mean, even with our affordable healthcare, people are already not seeking treatment!

You can put a price to your well-being

There are sacrifices if you have chronic pain, right? Maybe not if your pain intensity is low. But let’s say your pain is debilitating. It definitely affects your quality of life, mental well-being, work productivity. You probably already know that.

But it doesn’t stop there, does it?

Abortion has been previously reported to be directly associated with low back pain. There was a qualitative study where a lady shared her experience about aborting her child because of her pain. I can’t find the reference anymore but will circle back when I do.

Women with back pain can have reservations towards pregnancy. Indeed, it’s well documented that pregnancy can worsen chronic back pain.

So, brutally put, how much is having a child worth to you?

Pain can affect marriage life

Marriages in which one spouse has chronic pain is more likely to end in divorce. If you don’t have chronic pain or if your pain is mild, this is hard to appreciate. I promise you, though, it does happen.

For every client we take on, we always ask about their motivation. What is your end goal? How will you live your life differently should your pain go away?

One of our clients actually did explicitly express that they think their spouse will leave them should their chronic pain persist. I don’t think you can imagine how heart wrenching it is to hear someone say that out loud. While I am single, I also cannot imagine the courage it would take to share that with someone you are meeting for the first time.

I don’t think I will ever forget this client. When your motivation to help yourself is not because you need the physical pain relief, but because you love your spouse that much. I think that’s the epitome of true love. More real than fairytales, methink.

So, brutally put, again, how much is your marriage worth to you?

Finding freedom from pain

I don’t think my intention here is to get you to start seeking help for your pain. Though you should. Empirically, earlier interventions have better outcomes and lower healthcare spending.  What I think is more important is for you to consider how much your pain, or freedom from pain, worth to you.

People choose to live in pain for a whole bunch of reasons. I have had so many clients who refused medication because they just rather avoid it. It is your prerogative to have your own values. I respect that. I am not going to say medication is good for you. That’s obviously not true. I am also not saying that it’s wrong for you to live in pain.

If you are happy to live with your pain, then I am genuinely happy for you.

What you should consider today, or in the very near future, is how much you are giving up because of your pain. This could be implicit, so you may need to do some reflection. And with that, can you peg a dollar figure to that?

If so, is it more than $17.50?