Institute of Medicine Issues Blueprint for Pain in America

Allison Gandey

June 30, 2011

June 30, 2011 — There is a need for coordinated, national efforts to change attitudes toward pain, says an Institute of Medicine report released Wednesday.

The report, mandated by the US Congress and funded by the National Institutes of Health (NIH), shows the country has a long way to go to relieve pain in America.

The institute is part of the United States National Academies. The Keck Center of the National Academies is in Washington, DC.

The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services to enlist the Institute of Medicine to examine pain as a public health problem. It's estimated that 116 million Americans experience chronic pain, a condition that costs the nation up to $635 billion every year.

"Given the large number of people who experience pain and the enormous cost in terms of both dollars and the suffering experienced by individuals and their families, it is clear that pain is a major public health problem in America," the report's writing committee chair Philip Pizzo, MD, from Stanford University in California, said in a news release.

The committee says it would like to see the NIH designate one of its existing institutes to take the lead in pain medicine and increase the scope and resources of the NIH Pain Consortium.

But the report calls for action not only from the NIH. Committee members have unveiled what they are calling a blueprint for transforming prevention, care, education, and research. The report says that pain relief should be a national priority.

The report calls on the Centers for Disease Control and Prevention for epidemiologic data and public education. It also addresses the Agency for Healthcare Research and Quality and the Health Resources and Services Administration. The report also points to reimbursement-related problems and calls on the Centers for Medicare and Medicaid Services to help resolve them.

National Priority

The Institute of Medicine is recommending a population-level prevention and management strategy. The health department, the committee says, should develop a comprehensive plan with specific goals, actions, and timeframes. The plan should:

  • Heighten awareness about pain and its health consequences;

  • Emphasize prevention;

  • Improve pain assessment and management in the delivery of healthcare 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.

The report points to gaps in knowledge about pain across healthcare and society. "Educating health professionals about how to better understand pain and its causes will help bridge these gaps," the report points out.

The White House recently announced its first action plan to fight prescription drug abuse. Agencies have already started banding together to address the problem they say has become "an epidemic."

The Institute of Medicine report appears to support the US Food and Drug Administration's long-awaited opioid plan. The central component of the new opioid Risk Evaluation and Mitigation Strategy is an education program for prescribers. The agency will require drug makers to provide and pay for the plan.

Continuing Medical Education

"Improving education is especially important for primary care providers, given their key role in pain management," the reports states. "In addition, all care providers should keep their knowledge current by engaging in continuing education programs, and licensure, certification, and recertification examinations should include assessments of providers' pain education."

It is a complicated time for pain management. Prescription drug overdose death rates in the United States are at an all-time high. According to previous reports, there are more deaths from opioid overdoses than from heroin and cocaine overdoses combined. In some states, these rates are higher than deaths from automobile crashes. In addition to the clear human costs, an estimated 60% of hospital costs related to opioid overdoses are paid for with public funds.

As the issue garners increasing attention, many specialists worry legitimate patients will receive inadequate care.

All care providers should keep their knowledge current by engaging in continuing education programs.

"All too often, prevention and treatment of pain are delayed, inaccessible, or inadequate," Dr. Pizzo said. "Patients, healthcare providers, and our society need to overcome misperceptions and biases about pain."

Some of the recommended changes can be implemented by the end of 2012, including developing a comprehensive strategy, creating strategies to reduce barriers to care, supporting collaboration between pain specialists and primary care clinicians, and designating a lead institute at the NIH that is responsible for moving pain research forward, the committee writes. Other changes should be in place by 2015 and maintained as ongoing efforts.

"Healthcare providers, insurers, and the public need to understand that although pain is universal, it is experienced uniquely by each person and care — which often requires a combination of therapies and coping techniques — must be tailored. Pain is more than a physical symptom and is not always resolved by curing the underlying condition. Persistent pain can cause changes in the nervous system and become a distinct chronic disease."

This study was mandated by the US Congress and sponsored by the NIH. The researchers have disclosed no relevant financial relationships.

Institute of Medicine Report. Published online June 29, 2011.

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