Dwindling Support, Opioid Lawsuits Blamed for Pain Society's Demise

Alicia Ault

June 11, 2019

The former executive director and board president of the Academy of Integrative Pain Management (AIPM) are still grieving the loss of the organization and expressed concern that solutions offered by its membership may not be heard elsewhere.

The AIPM closed its doors at the end of January, leaving behind a three-decade legacy of bringing together clinicians, policy experts, mental health professionals, social workers, acupuncturists, massage therapists, and other healers to address acute and chronic pain.

"No other organization was as heavily into supporting chiropractic, massage, and acupuncture," Bob Twillman, PhD, the former AIPM executive director, told Medscape Medical News. "Now the biggest group that advocated for that is gone."

Twillman said he found it ironic that AIPM, a primary mover in promoting non-opioid approaches to pain management, is now gone, at a time when the need for those alternative methods is finally being recognized.

"Everybody seems to get that message now on the tail end of the opioid prescribing crisis," agreed W. Clay Jackson, MD, the former AIPM board president, and currently director of palliative care for the West Cancer Center in Memphis, Tennessee.

"AIPM's inability to continue to exist has left an important deficit in the field," Jackson told Medscape Medical News. The organization had a special role as "a trusted broker that a number of stakeholders could come to for fair debate."

AIPM's inability to continue to exist has left an important deficit in the field…the organization had a special role as a trusted broker that a number of stakeholders could come to for fair debate. Dr W. Clay Jackson

Jackson added that he regrets that AIPM can't continue its advocacy. And despite the support and trust of many loyal members, "we were unable to succeed in our mission. And that was deeply painful," Jackson said.

Dwindling Industry Support

Twillman and Jackson cite a number of factors that led to the organization's dissolution, including declining membership, a reduction in industry support for conferences and educational programs, and a failure to capitalize on its unique niche among pain organizations.

AIPM began in 1988 as the American Academy of Pain Management. In 2016, it assumed the new name, adding the word integrative to better reflect its mission.

But for most of its existence, "it was hard to differentiate us from other organizations involved in pain," said Jackson, noting a plethora of groups dedicated to pain management, research, and advocacy.

The AIPM held its last annual meeting in November in Boston. Jackson said these meetings — 28 in total — were among the organization's best work, especially in the last few years.

But the membership did not wholly support in-person learning — a factor that's hurting other professional membership organizations, said Jackson.

Overall, younger clinicians aren't as interested in joining professional groups or attending meetings, he said.

"They want the products they can get but don't want to pay the membership fees," said Twillman.

Jackson said membership had declined dramatically, from 4000 in 2015 to about 2000 in 2019.

AIPM had been struggling financially for a few years, said Twillman. "I feel like I spent the last three years running up the down escalator trying to keep things going," he said.

In January, it was apparent that "the only way we'd make it through the year is if every assumption [that] we made turned out that way. Ultimately, the board decided to close up shop rather than keep selling admissions to the annual meeting," Twillman said.

Opioid Lawsuits a Factor

At the same time membership was declining, pharmaceutical industry support — largely from opioid manufacturers — had dropped precipitously.

Grants and revenues from exhibitors were important — though not significant — financial sources for the annual meeting, as were unrestricted grants for advocacy and other educational programs, said Twillman. Starting in 2015, opioid makers began withdrawing their support, just as lawsuits began to pile up naming them as defendants, he said.

Twillman noted two factors played into the AIPM's demise: First, the sponsors did not want to give the impression that they were using advocacy or clinical organizations as marketing fronts. Second, they wanted to reduce expenses in anticipation of having to pay out settlements or judgements.

By 2018, pharmaceutical support had dropped to about $50,000 total. In some previous years, a single company might spend $100,000 at a single meeting.

"I don't think anybody anticipated the lawsuits," Twillman said. "No one anticipated the response being immediately turning off the spigot.

"I don't have any regrets about accepting that money — the regret is we couldn't develop other sorts of funding when that went away."

The problem was finding equally deep-pocketed companies or organizations; most don't have the pharmaceutical industry's wealth, said Twillman.

The only option was to raise membership fees, increase the annual meeting fee, or advertising prices. But any of those would likely have sparked a further drop in membership, said Twillman.

Another One Bites the Dust?

Meanwhile, The American Pain Society (APS) is also blaming declining membership and its association with opioid manufacturers for bringing it to the brink of extinction.  

In late May, as reported by Medscape Medical News, the APS board of directors urged its membership to consider filing for chapter 7 bankruptcy. The APS has been named in some lawsuits filed against opioid makers, which has led to an uncertain future, said the Board. The litigation, combined with declining membership and meeting attendance, has doomed APS, the Board said.

The APS membership voted on the bankruptcy recommendation on May 29, but the outcome is not clear yet. The results will be made public after the Board approves the vote, APS spokesman Chuck Weber told Medscape Medical News.

Jackson is disheartened by the notion that pain organizations are in decline, especially AIPM. The fact that AIPM can no longer serve as a clinical and educational home for integrative approaches to pain "is deeply troubling," on a professional and personal basis, said Jackson.

"No one wants to be the person who had to preside over the demise of an organization," he added.

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