Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 269
6 A Blueprint for Transforming Pain Prevention, Care, Education, and Research Progress occurs when courageous, skillful leaders seize the opportunity to change things for the better. —Harry S Truman This report has provided an overview of the causes, impact, prevalence, and scope of pain; presented pain as a public health problem; identified barriers to high-quality and accessible pain care; delineated specific groups that may be undertreated for pain; outlined strategies for improving the training of pain researchers; and described opportunities for public–private partnerships and col - laborations in pain research, care, and education. The report has also identified challenges in educating patients, the public, and providers with respect to pain and examined the current state of basic knowledge about pain and ways in which pain research is funded and organized. In reviewing the evidence in these areas, the report has identified knowledge gaps, barriers, opportunities to move the field forward, and ways to transform how pain is understood and treated. The committee’s goal in preparing this report was to provide a broad over- view of the topics included in its charge (see Chapter 1, Box 1-1) and delineate a direction and priorities for achieving change. The committee recognizes that other groups, such as the Interagency Pain Research Coordinating Committee and the Pain Consortium of the National Institutes of Health (NIH), will make use of the broad direction provided by this report and undertake their own processes to improve the understanding of pain and its treatment. 269
OCR for page 270
270 RELIEVING PAIN IN AMERICA As discussed in Chapter 2, pain is experienced by virtually everyone yet is unique in its perception and experience for each person. Accordingly, broad rec - ommendations such as those offered by the committee can yield general change, but not improvement that will be palpable to every affected individual. A standard clinical algorithm for diagnosing and treating every patient lies well beyond the scope of this report (and may not be achievable in any event). The committee did not analyze the complexities of individual pain conditions and diseases associated with pain. Nor did it analyze in depth the controversies surrounding opioid abuse and diversion. However, the committee hopes that its findings and recommenda - tions will be transformative for the lives of many of the approximately 100 mil - lion American adults experiencing chronic pain and those with acute pain as well. The committee determined that transforming pain prevention, care, educa - tion, and research will require carefully planned and coordinated actions by numerous leaders and organizations. Many actors should contribute to the for- mation of a new national pain strategy. For example, the NIH Pain Consortium should be strengthened and its activities expanded. A comprehensive strategy will ensure that actions to address the problem of pain will be both efficient and effective. The recommendations in this report are designed to assist policy makers; fed- eral agencies within and outside the Department of Health and Human Services; state and local health departments; primary care practitioners; pain specialists; other health professionals; health care provider organizations; health professions associations; private insurers; researchers; funders; educators; pain advocacy and awareness organizations; the public; and, most important, people living with pain and their families, friends, and colleagues. The ultimate goal is to improve outcomes of care and return people to their maximum level of functioning. The basis for the committee’s recommendations consists of scientific evidence, direct testimony, and the expert judgment of the committee’s diverse membership. Prin- ciples underlying the recommendations were presented in Chapter 1 (Box 1-2). They include • pain management as a moral imperative, • chronic pain as sometimes a disease in itself, • the value of comprehensive treatment, • the need for interdisciplinary approaches, • the importance of prevention, • wider use of existing knowledge, • recognition of the conundrum of opioid use, • collaborative roles for patients and clinicians, and • the value of a public health- and community-based approach. This chapter organizes the recommendations presented in Chapters 2 through 5 into a blueprint for action by identifying them as either immediate or near-term
OCR for page 271
271 PAIN PREVENTION, CARE, EDUCATION, AND RESEARCH and enduring. The immediate recommendations are those the committee believes should be initiated now and completed before the end of 2012. The near-term and enduring recommendations build on these immediate actions, should be completed before the end of 2015, and should be maintained as ongoing efforts. Table 6-1 presents the recommendations in these two categories, along with the relevant actors and the recommendations’ key elements. (Note that the numbering scheme used in Chapters 2 through 5 is preserved here.) The committee wishes to emphasize that the comprehensive population health-based strategy set forth in Recommendation 2-2 should inform actions taken in response to, or consistent with, all of the other recommendations. The strategy should be comprehensive in scope, inclusive in its development, expedi - tious in its implementation, and practical in its application. Most important, the strategy must be far-reaching. As evidenced in this report, pain is a major reason for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Further, pain costs the country $560-635 billion a year according to a new, conservative estimate developed as part of this study. Given the burden of pain in terms of human lives, dollars, and social consequences, actions to relieve pain should be undertaken as a national priority. REFERENCE Perez, T., P. Hattis, and K. Barnett. 2007. Health professions accreditation and diversity: A review of current standards and processes. Battle Creek, MI: W.K. Kellogg Foundation. http://www. jointcenter.org/healthpolicy2/hpi-lib/Accreditation.pdf (accessed June 6, 2011).
OCR for page 272
272 RELIEVING PAIN IN AMERICA TABLE 6-1a Blueprint for Transforming Pain Prevention, Care, Education, and Research IMMEDIATE: Start now and complete before the end of 2012 Recommendation Actors Key Elements of Recommendation 2-2. Create a Secretary of Health and Involve multiple federal, state, and comprehensive Human Services (HHS) private-sector entities, such as the population health- National Institutes of Health (NIH), level strategy for Food and Drug Administration pain prevention, (FDA), Centers for Disease Control treatment, and Prevention (CDC), Agency for management, and Healthcare Research and Quality research (AHRQ), Health Resources and Services Administration (HRSA), Centers for Medicare and Medicaid Services (CMS), Department of Defense (DoD), Department of Veterans Affairs (VA), outcomes research community and other researchers, credentialing organizations, pain advocacy and awareness organizations, health professions associations (including pain specialty professional organizations), private insurers, health care providers, state health departments, Medicaid programs, and workers’ compensation programs 3-2. Develop HHS Secretary, AHRQ, CMS, Key part of the strategy envisioned in strategies for HRSA, Surgeon General, Recommendation 2-2 reducing barriers to Office of Minority Health, pain care Indian Health Service, VA, DoD, large health care providers (e.g., accountable care organizations) 3-4. Support CMS, VA, DoD, health care The pain specialist role includes collaboration between providers, pain specialists, serving as a resource for primary care pain specialists pain centers, primary care practitioners and primary care practitioners, pain specialty clinicians, including professional organizations, referral to pain primary care professional centers when associations, private insurers appropriate
OCR for page 273
273 PAIN PREVENTION, CARE, EDUCATION, AND RESEARCH TABLE 6-1 Continued Recommendation Actors Key Elements of Recommendation 5-1. Designate a NIH Involve pain advocacy and awareness lead institute at the organizations; foster public-private National Institutes of partnerships Health responsible for moving pain research forward, and increase the support for and scope of the Pain Consortium NEAR-TERM AND ENDURING: Build on immediate recommendations, complete before the end of 2015, and maintain as ongoing efforts Recommendation Actors Key Elements of Recommendation 2-1. Improve the National Center for Health Based on Recommendation 2-2; foster collection and Statistics (NCHS) (part public–private partnerships; includes reporting of data on of CDC), AHRQ, CMS, subpopulations at risk for pain and pain VA, DoD, state and local undertreatment of pain, characteristics health departments, private of acute and chronic pain, and health insurers, outcomes research consequences of pain (morbidity, community, other researchers, mortality, disability, related trends) large health care providers, designers of electronic medical records 3-1. Promote Health professions Requires the development of better and and enable self- associations (including more evidence-based patient education management of pain pain specialty professional products organizations), pain advocacy and awareness organizations, health care providers 3-3. Provide CMS, VA, DoD, graduate Improved health professions education educational medical education (GME) requires a stronger evidence base opportunities in and continuing medical on clinical effectiveness and more pain assessment and education (CME) primary interdisciplinary training and care treatment in primary care programs (backed by care accreditation, licensure, and certification authorities and examiners), nurse practitioner and physician assistant training programs, researchers, health care providers continued
OCR for page 274
274 RELIEVING PAIN IN AMERICA TABLE 6-1 Continued Recommendation Actors Key Elements of Recommendation 3-5. Revise CMS, VA, DoD, Medicaid Requires the development of more reimbursement programs, private insurers, evidence on clinical effectiveness and policies to foster health care providers, health collaboration between payers and coordinated and professions associations providers evidence-based pain (including pain specialty care professional organizations), pain advocacy and awareness organizations 3-6. Provide Health care providers, WHO should add pain to the consistent and primary care practitioners, International Classification of complete pain pain specialists, other health Diseases, Tenth Edition (ICD-10) assessments professions, pain clinics and programs, World Health Organization (WHO) 4-1. Expand and FDA, CDC, AHRQ, CMS, Focus is on patient education and redesign education Surgeon General, DoD, VA, public education; includes pain programs to pain advocacy and awareness prevention transform the organizations, health understanding of professions associations pain (including pain specialty professional organizations), private insurers, health care providers 4-2. Improve CMS, HRSA Bureau CMS’s role is that of payer for GME; curriculum and of Health Professions, include interdisciplinary training accrediting organizations,b education for health care professionals undergraduate and graduate health professions training programs (backed by licensure and certification authorities and examiners) 4-3. Increase the Pain medicine fellowship Requires more effort to attract young number of health programs and graduate health professionals to pain programs; professionals with education programs in also requires collaboration between advanced expertise in dentistry, nursing, psychology educators and clinicians pain care and other mental health fields, rehabilitation therapies, pharmacy, and other health professions
OCR for page 275
275 PAIN PREVENTION, CARE, EDUCATION, AND RESEARCH TABLE 6-1 Continued Recommendation Actors Key Elements of Recommendation 5-2. Improve FDA, NIH, pharmaceutical Based on Recommendation 5-1; the process for manufacturing and research involves developing new and faster developing new industry, academically ways to evaluate and approve new pain agents for pain based biomedical research therapies, e.g., novel forms of patient control community, private funders of stratification in clinical trials and novel pain research investigative endpoints 5-3. Increase support NIH, AHRQ, CDC, DoD, Based on Recommendation 5-1; basic, for interdisciplinary VA, pharmaceutical translational, and clinical studies research in pain manufacturing and research should involve multiple agencies and industry, private funders of disciplines; focus on knowledge gaps pain research, academically based biomedical research community, pain advocacy and awareness organizations 5-4. Increase NIH, AHRQ, CDC, DoD, Based on Recommendation 5-1; the conduct of VA, pharmaceutical includes translational, population longitudinal research manufacturing and research health, and behavioral aspects of pain in pain industry, Patient-Centered care (social and multimodal aspects, Outcomes Research Institute, not just medications and other single private funders of pain modalities); focus is on real-world research, academically situations (comparative effectiveness, based biomedical research not just efficacy); foster public–private community, outcomes partnerships research community, pain advocacy and awareness organizations 5-5. Increase the NIH, NCHS, AHRQ, CMS, Includes more interdisciplinary training training of pain academic medical institutions researchers a The committee prepared this table based on the recommendations but with a focus on their imple - mentation. The table lists a range of potential actors and key elements of each recommendation. b Accrediting organizations include the Liaison Committee on Medical Education, Commission on Osteopathic College Accreditation, Accreditation Council for Graduate Medical Education, Com - mission on Dental Accreditation, Commission on Collegiate Nursing Education, National League for Nursing Accreditation Commission, American Psychological Association Committee on Accredita - tion, Council on Education for Public Health, Council on Social Work Education, and Council for Higher Education Accreditation (Perez et al., 2007).
OCR for page 276