Pain Report Seen as "A Major Step Forward" in Care and Prevention

Recommendations on pain prevention, care, education, and research intended to achieve a cultural transformation in the way pain is understood, viewed, assessed, and managed are provided in an Institute of Medicine (IOM) report recently submitted to Congress. The American Pain Society (APS) characterized the report, Relieving Pain in America: A Blueprint for Transforming Prevention, Treatment, and Research, as a major step forward in addressing the nation's leading public health problem, untreated and undertreated chronic pain.

Every year, pain is experienced by at least 116 million adult Americans-more than the total affected by heart disease, cancer, and diabetes mellitus combined-and medical treatment and lost productivity costs are between $560 billion and $635 billion, the report found. Much of the pain is preventable or could be better managed, and several policy initiatives could emerge from the recommendations, including recognition of the benefits of multidisciplinary pain care and improved pain education and training for clinicians, it was noted.

Highlights of the IOM report include the following:
• Fostering a cultural transformation. A transformation is needed to better prevent, assess, treat, and understand pain. Government agencies, health care providers, health care professional associations, educators, and public and private funders of health care should take the lead.

• Pain as a public health challenge. The nation must adopt a population-level prevention and management strategy. The US Department of Health and Human Services should develop a comprehensive plan with specific goals, actions, and time frames to heighten awareness about pain and its health consequences, emphasize pain prevention, improve pain assessment and management in the delivery of health care and financing programs of the federal government, use public health communication strategies to inform patients on how to manage their own pain, and address disparities in the experience of pain among subgroups of Americans.

Federal and state agencies and private organizations should accelerate the collection of data on pain incidence, prevalence, and treatments. Data should be collected at regular intervals using standardized questions, protocols for surveys, and electronic medical records to identify subpopulations at risk; characteristics of acute and chronic pain; profound health consequences of pain, including death, disease, and disability; and related trends over time.

• Care of persons with pain. Because pain prevention, assessment, and treatment are inadequate for many persons, health care providers should aim increasingly at tailoring pain care to each person's experience and should promote pain self-management. Primary care physicians should collaborate with pain specialists in cases in which pain persists. Public and private insurers can help by offering incentives to support delivery by primary care physicians of coordinated, evidence-based, interdisciplinary pain assessment and care for persons who experience complex pain. Government agencies, health care providers, and public and private funders of health care should adopt a comprehensive, strategic approach to reduce or eliminate barriers that limit the availability of pain care and contribute to the disparities found among some groups.

Federal agencies and other stakeholders should redesign education programs for improved understanding of pain among patients, the public, and health care providers. Undergraduate and graduate training programs should offer standardized information about pain and include experience in caring for pain in interprofessional settings. All care providers should keep their knowledge current by engaging in continuing education programs; licensure, certification, and recertification examinations should include assessments of providers' pain education.

• Research challenges. An existing NIH institute should be designated the lead institute for pain. Also, the NIH Pain Consortium should take a stronger leadership role in effecting the necessary transformation in how pain research is conducted.

• Blueprint for action. Some of the recommendations, including developing a comprehensive strategy, developing strategies to reduce barriers, supporting collaboration between pain specialists and primary care clinicians, and designating a lead institute at the NIH for pain research, should be implemented by the end of 2012. Others should be ongoing efforts that should be put in place by the end of 2015.

For more information about this report and other pain management initiatives, visit the APS Web site at http://www.ampainsoc.org. Or, contact the organization at American Pain Society, 4700 W Lake Ave, Glenview, IL 60025; telephone: (847) 375-4715; fax: (866) 574-2654 or (847) 375-6479; international fax: (732) 460-7318.