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Index A Advocates, for patients with chronic pain, 24, 31, 34, 115, 184, 190, 224, 228, 239 Abuse. See also Medications for pain Afghanistan conflict, 81, 157–158 of opioids, 146–147 African Americans, disparities in prevalence Acceptance, new emphasis on, 44 and care for, 67–70, 310 Access to opioid analgesics, 142–148 Agency for Healthcare Research and Quality abuse of opioids, 146–147 (AHRQ), 6, 12–13, 56, 61, 72, 99, 101, effectiveness of opioids as pain relievers, 143, 189, 249, 253–254, 304 144–145 Aging, conditions associated with, 79 need for education, 145–146 Alaska Natives, disparities in prevalence and opioid use and costs of care, 147–148 care for, 72–73 patient access to opioids, 143–144 Allodynia, 35, 277 Access to pain care, 127–128 Allostatic load, 37, 277 Accreditation Council for Graduate Medical Alternative medicine. See Complementary and Education (ACGME), 193, 200, 210 alternative medicine (CAM) services Acetaminophen, 130 Alzheimer’s Association, 189 Activities of daily living, effects of pain on, Alzheimer’s disease, campaigns to educate 86, 139 about, 188–189 Acupuncture, 135–136, 208 Alzheimer’s Disease Education and Referral Acute pain, 1, 32–33, 277 Center, 189 better treatment for, 100 American Academy of Family Physicians, 197 choice of a treatment approach for, 124, 126 American Academy of Neurology, 199, 249 common sources of, 29 American Academy of Orofacial Pain, 120 Addiction, 36, 277 American Academy of Orthopedic Surgeons, Adequacy of pain control, in hospitals and 303 nursing homes, 140–141 American Academy of Pain Management, 120 Adherence to drug regimen, problems with, 131 American Academy of Pain Medicine, 120, 123 Adjusting to pain. See Pain adjustment American Association of Colleges of Nursing, Advance directives, campaigns to educate 202 about, 188 349

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350 INDEX American Association of Naturopathic American Society of Regional Anesthesia and Physicians, 209 Pain Medicine, 120 American Association of Orthopaedic American Urological Association, 248 Medicine, 209 Analgesia, 31, 71, 76, 277 American Back Society, 120 Analgesic Clinical Trials, Innovations, American Board of Anesthesiology, 121, 198 Opportunities, and Networks American Board of Medical Specialties (ACTION) initiative, 231–232, 246 (ABMS), 198–199, 210 Anesthetic interventions, for treating people American Board of Pain Medicine (ABPM), with pain, regional, 131 198 Anger, 4, 42 American Cancer Society (ACS), 57, 143, Annex 5-1. See “Mechanisms, Models, 188, 239 Measurement, and Management in American Chronic Pain Association, 34, 189 Pain Research Funding Opportunity American College of Emergency Physicians, Announcement” 203 Antianxiety medication, 78 American Dental Association (ADA), 207 Anxiety, 4, 41 American Diabetes Association, 57 Arthritis, improvements in, 118 American Geriatrics Society, 143 Asian Americans Foundation for Health in Aging, 189 disparities in prevalence and care for, American Headache Society, 120 71–72, 310 American Heart Association, 239 language problems for, 65 American Holistic Medical Association, Assessment 208–209 dimensions of pain, 236–237 American Indians, disparities in prevalence ongoing, and monitoring of pain and pain- and care for, 72–73 related states, 238 American Medical Association (AMA), 120 of pain, 8, 138, 164–165, 262–263 Pain and Palliative Medicine Specialty of psychological traits and states related to Section Council, 191 pain adjustment, 237–238 American Medical Directors Association, 143 Assistance with Pain Treatment, 122 American Neurological Association, 199 Association of American Medical Colleges, 194 American Nurses Association (ANA), 203 Australia American Nurses Credentialing Center, 203 national cost of pain in, 92–93 American Pain Foundation (APF), 145, 189, public education campaign on low back 300 pain, 97, 185–186 American Pain Society, 120, 143, 203 Avoidance, about pain, 88 Clinical Centers of Excellence Awards Program, 161 B American Physical Therapy Association, 207 Back Beliefs Questionnaire (BBQ), 185–186 American Productivity Audit telephone survey, Barriers to effective pain care, 8–9, 152–157 86 cultural attitudes of patients, 156–157 American Psychological Association (APA), geographic barriers, 157 205–206 insurance coverage, 156 Committee on Accreditation, 210 magnitude of the problem, 9, 153 American Recovery and Reinvestment Act, provider attitudes and training, 153–156 245 regulatory barriers, 157 American Society for Pain Management written public testimony on, 294 Nursing, 120, 203 Barriers to improving pain care American Society of Interventional Pain clinician-level barriers, 45–46 Physicians, 120 overview of, 45–47

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351 INDEX patient-level barriers, 46–47 conclusion, 161 potential savings from improvements in, findings and recommendations, 161–165 100 issues in pain care practice, 137–152 system-level barriers, 45 models of pain care, 158–161, 227–228 Basic knowledge outcomes-based, 298 biomarkers and biosignatures, 221–222 overtreating, 299 conclusion, 223 potential savings from improvements in, expanding, 220–223 100 opportunities in psychosocial research, 223 treatment modalities, 129–137 other promising basic research, 222–223 treatment overview, 115 Behavioral Risk Factor Surveillance System Cartesian model, of mind-body separation, 35 survey, 147 Catastrophic injuries and diseases, x, 81. See Behavioral therapy, 132–133, 299 also Pain catastrophizing Beliefs, 42, 71, 277 Causes of pain, 34–44 about pain, 183, 185 the brain’s role, 38–40 Best Pharmaceuticals for Children Act, 78 cognitive context, 42–44 Biofeedback, 132, 226 the complexity of chronic pain, 34–36 Biological changes, caused by pain, 31 emotional context, 40–42 Biological factors in pain, 24 genetic influences, 36–37 Biomarkers and biosignatures, 220–222 nerve pathways, 38 Biomarkers Consortium, 247 pain in childhood, 37 “Biopsychosocial model,” 35, 42, 115, 127, Center for Studying Health System Change, 227, 277 148 education in, 183, 219–220 Centers for Disease Control and Prevention Blueprint for transforming pain prevention, (CDC), 12–13, 56, 99, 189, 253 care Centers for Medicare and Medicaid Services education, and research, 14–17, 269–275 (CMS), 11–13, 82–83, 210, 249, 254 immediate goals, 272–273 Minimum Data Set, 83 near-term and enduring goals, 273–275 Centers of Excellence in Primary Care Brain, role in the causes and persistence of Education, 203 pain, 38–40 Central sensitization, 33 Brennan, F., et al., 34 Cerebrovascular disease, 82 Brief Pain Inventory, 237 Certifying physicians, 198, 210 Brigham and Women’s Pain Management Challenges. See Education challenges; Center, 161 Research challenges British Pain Society, 219 Children Bureau of Health Professions, 210 causes and persistence of pain in, 37 Bureau of Labor Statistics, 80 disparities in prevalence and care for, 77–78, 192 Chiropractic spinal manipulation, 135, 208 C Choice of a treatment approach, 124–127 environmental factors affecting, 125 Canada, public education campaign on low individual-related factors affecting, 125 back pain, 186 pain-related factors affecting, 125 Cancer patients, 314 Chronic fatigue syndrome, 75 disparities in prevalence and care for, 84 Chronic pain, 1, 32–33, 278, 295 fear in, 43 choice of a treatment approach for, Cardiovascular patients, 131 126–127 Care of people with pain, 113–177. See also common sources of, 29 Barriers to improving pain care complexity of, 34–36, 300 barriers to effective pain care, 153–157 as a disease in itself, 4, 26 blueprint for transforming, 14–17, 269–275

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352 INDEX growing public understanding of, 63 Comprehensive Severity Index (CSI), 235 inversely related to socioeconomic status, Comptroller General of the United States, 74–75 248 life-cycle factors associated with the Concerns about opioid analgesic use, 142–148 development of, 30 abuse of opioids, 146–147 reductions in complications associated effectiveness of opioids as pain relievers, with, 100 144–145 Chronic Pain Policy Coalition, 219 need for education, 145–146 City of Hope National Medical Center, 204 opioid use and costs of care, 147–148 Clinical Centers of Excellence Awards patient access to opioids, 143–144 Program, 161 Consumer Price Index (CPI), Medical Care Clinical pharmacy specialist, 129 inflation index of, 302 Clinical Trials Transformation Initiative, 231 Control variables, in the economic costs of Clinician-level barriers, to improved pain care, pain, 306–307 45–46 Cost models for selected pain conditions Clinicians, roles for, 3, 22 incremental, 316–317 CME credit, 193, 195–196 indirect, 323–324 Cognitive-behavioral therapy, 43, 132, 207, Costs of pain and its treatment, 91–95. See 226, 278 also Direct costs; Economic costs Cognitive context, of the causes and of pain; Emotional cost of pain; persistence of pain, 42–44 Incremental costs; Indirect costs Cognitive impairments, disparities in to families, 94–95 prevalence and care for people with, to the nation, 56, 91–93 82–83 opioid use and, 147–148 Collaboration, need to support, 9, 163–164 and savings from a public health approach, Collins, Francis S., 240 100 Commission on Accreditation of Rehabilitation Counseling, 4 Facilities, 123 Cowan, Penny, 34 Commissioned paper, 283, 301–337 Cowley, Terrie, 184, 217, 224 Committee on Accreditation (of the APA), 210 COX inhibitors, 225 Committee on Advancing Pain Research, Care, Credentialing physicians, 198 and Education, 301 Croft, P., et al., 95 Agendas for Public Sessions, 284–291 Cross-fertilization of ideas, 45, 121 charge to, 2 Cross-sectional analysis, 314 description of, x, 281, 339–348 Cultural attitudes of patients, a barrier to Committee on Dental Accreditation (CODA), effective pain care, 156–157 206 Cultural transformation, 47–49 Common Fund (of the NIH), 241 and barriers to improved pain care, 45–47 Community-based approach, value of, 3 need for, 44–49, 209, 250–251 Comparative effectiveness research (CER), in the way pain is viewed and treated, 3–4 228, 232–234 Current partnership activities, 245–248 Competency-based education, 197 Complementary and alternative medicine D (CAM) services education in, 208–209 Daily living. See Activities of daily living reduced costs associated with, 93 Data on the economic costs of pain, 304–307 for treating people with pain, 93, 134–136 control variables, 306–307 Complexity of pain, 8, 24–26. See also dependent variables, 305–306 Unknown causes of pain key independent, 305 Comprehensive Pain Center of Sarasota, sample, 304–305 Florida, 161

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353 INDEX Drug Enforcement Administration (DEA), Data sources and methods, 281–291. See also 97, 297 Economic Costs of Pain in the United Drugs for pain. See Medications for pain States, The Duke University, 231 commissioned paper, 283, 301–337 Dysmenorrhea, 33 description of the study committee, 281 and limitations, 59–61 literature review, 282 E need to improve, 6, 101–102, 123–124 public meetings, 282–291 Economic costs of pain shortcomings of, 60 control variables, 306–307 Databases, 234–236 data on, 304–307 Grey Literature, 282 dependent variables, 305–306 Workers’ Compensation, 304 key independent, 305 Deficits, in problem-solving ability, 88 sample, 304–305 Dementia, 83 written public testimony on, 296 Dentistry, education in, 204, 206–207 Economic Costs of Pain in the United States, Department of Defense, 13, 56, 81, 114, 246, The, 301–337 253 background, 302 model of pain care, 160 conclusion, 303 Department of Health and Human Services data, 302, 304–307 (HHS), 2, 7, 20, 56, 102 discussion, 313–314 Department of Veterans Affairs, 5, 13, estimation strategy, 307–309 56, 80–82, 93, 114, 122, 206, 246, Education 253 competency-based, 197 Centers of Excellence in Primary Care Internet-based, 197 Education, 203 potential savings from improvements in, model of pain care, 158–160 100 Pain Research Program, 242 Education challenges, 10, 179–216 Dependent variables, for the economic costs of about opioid analgesic use, need for, pain, 305–306 145–146 Depression, xi, 4, 41, 70, 88, 118 blueprint for transforming, 10–11, 14–17, Descartes, René, 34 269–275 Diagnosing pain. See Pain diagnoses in complementary and alternative medicine Direct costs (CAM), 208–209 for medical care for pain diagnoses, conclusion, 209 312–313 in dentistry, 206–207 for selected pain conditions, 337 findings and recommendations, 209–210 Disability. See Functional disability; Pain- for the health professions, 56, 163, related disability; Work disability 204–209 Discussion, on the economic costs of pain, nurse education, 201–204 313–314 patient education, 180–184 Disease. See also Catastrophic injuries and for patients, 180–184 diseases in pharmacy, 208 chronic pain as, 3, 22, 26 in physical and occupational therapy, chronic pain developing into, ix 207–208 validation accorded by, x physician education, 190–201 Disparities in prevalence and care. See also of primary care physicians, 196–198 Health disparities in psychology, 204–206 by age group, 77–80 public education, 184–190 of pain in children, 77–78 tools useful in reaching the public, of pain in the elderly, 78–80 187–188

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354 INDEX F Educational background, disparities in prevalence and care by, 73–75 Families Effectiveness, of opioids as pain relievers, costs of pain and its treatment to, 94–95 144–145 viewed as entities, 94 Effects of pain Fatalism, “deeply-rooted value and belief in,” on activities of daily living, 86 71 on productivity, 86–87 Fatigue, xi. See also Chronic fatigue syndrome on quality of life, 87–88 Federal agencies. See also individual agencies on the risk of suicide, 88–89 and departments Elderly, disparities in prevalence and care for, role of, 56 78–80 Federal research funding, obtaining, 244–245 Electronic health record systems, 101 Federation of State Medical Boards, Medical Electronic prescription monitoring system, and Osteopathic Practice Act (model), calls for, 298 191 Emergency Nurses Association, 203 Ferrell, Betty, 202 Emotional context, of the causes and Fibromyalgia, 75, 121, 137, 153 persistence of pain, 40–42 Fifth vital sign approach, 139–141 Emotional cost of pain, 5 Findings and recommendations, 4–13, 100 Emotional support, importance of, 95 audiences for, 23, 57 End of life in caring for people with pain, 8–10, disparities in prevalence and care for 161–165 people at, 85 conclusions, 4, 13 pain and suffering at, 141–142, 188 education challenges, 10–11, 209–210 Endometriosis, 75, 78 public health challenges, 5–7, 100–103 Enduring goals, for transforming pain research challenges, 11–13, 250–254 prevention, care, education, and First National Pain Medicine Summit, 191 research, 271, 273–275 Food and Drug Administration (FDA), 12–13, English as a second language, disparities in 56, 99, 142, 224, 230, 252 prevalence and care for patients with, Office of Critical Path Programs, 231 65–66 Regulatory Science Initiative, 224 Environments Foundation for Health in Aging, 189 as factors in pain, 36 Functional disability, 310–314 unhealthy, 37 Functional neuroimaging, to investigate pain, unsafe, 96 39 Epidemiology, of pain, 264–265 Functioning, hampered by pain, xi, 139–140 Estimation strategy for the economic costs of Future of the Public’s Health in the 21st pain, 307–309 Century, The, 57 health care expenditure models, 307–308 indirect cost models, 308–309 Ethnicity. See Racial and ethnic factors G Evidence-based pain care. See Pain care Exercise, in pain management, 133–134 Gaskin, Darrell J., 301–337 Existing knowledge, wider use of, 3, 22 Gender Expenditure models, total, for selected pain differences in the seriousness of pain by, conditions, 319–320 89–90 Expenditures, for selected pain conditions, disparities in prevalence and care by, 318 75–77 Experiences providing pain treatment, written Generalized linear model, hourly wages public testimony on, 294 models for selected pain conditions, 332–333

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355 INDEX Genetic factors in pain, 36–37, 221–222, 260 Hospice patients, 85, 141–142 Genomic data, 233, 235 Hospitals, adequacy of pain control in, Geographic barriers, to effective pain care, 140–141 80, 157 Hourly wage reductions Glial cells, 222, 260 for adults with selected pain conditions, “Global Year Against Acute Pain,” 219 327 Goals, for transforming pain prevention, care, due to selected pain conditions, 336 education, and research, 270–271, Hourly wages models, for selected pain 273–275 conditions, logistic regression and Gooddy, William, 191 generalized linear, 332–333 Grey Literature database, 282 Hours worked. See also Missed hours models for adults with selected pain conditions, Guidelines for Teaching the Comprehensive 312, 326 Control of Pain and Sedation to Dentists and Dental Students, 207 Hurricanes, 157 Hydrocodone, 130 Hyperalgesia, 35, 278 H Hypnosis, 132–133, 226 Headaches, 136 fiscal challenge of caring for, 149 I migraines, 87 Healing, pain persisting after, 35 Ibuprofen, 130 Health. See also Pain as a public health Imaging, to investigate pain, 38–39 challenge Immediate goals, for transforming pain impact of pain on physical and mental, prevention, care, education, and 31–32 research, 270, 272–273 influence of occupational rank on, 74 Impact of pain, written public testimony on, Health and Retirement Study, 68, 72 295 Health care expenditure models, estimation Improving pain care, written public testimony strategy for, 307–308 on, 294 Health disparities, 265–266 Income, disparities in prevalence and care by, Health literacy, 66 73–75 low rates of, 66 Incremental cost models, for selected pain Health Psychology Network, 205 conditions, dependent and independent Health Resources and Services Administration, variables used in, 316–317 11, 210 Incremental costs Healthcare Effectiveness Data and Information of health care, 308–311 Set (HEDIS), 149–150 of medical expenditures, by source of Healthy People 2020, 57–58 payment, 322 Pain Relief Objectives, 58 of medical expenditures for selected pain Heart surgery, complications following, 84 conditions, 321 Heckman selection models, 309 of number of days of work missed because Helplessness, about pain, 88 of selected pain conditions, 334 Herman, Gwenn, 180 of number of hours of work missed Hip replacement surgeries, 132 because of selected pain conditions, Hispanics 335 disparities in prevalence and care for, Independent factors, in the economic costs of 70–71, 310 pain, 305 language problems for, 65–66 Indian Health Service (IHS), 72, 96 HMO Research Network, 234 Indirect cost models Hopelessness, about pain, 88 estimation strategy for, 308–309

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356 INDEX J for selected pain conditions, dependent and independent variables used in, 323–324 Jane B. Pettit Pain and Palliative Care Center, Indirect costs 161 associated with reductions in wages due to Joint Commission on Accreditation of selected pain conditions, 336 Healthcare Organizations, 138, 140 of health care, 311–312 Joint pain, 79, 86 Inflammation, causing pain, 33 Joint replacement statistics, among Medicare Initiative on Methods, Measurement, and beneficiaries, 132 Pain Assessment in Clinical Trials Judgmentality, 46 (IMMPACT), 231, 246 Injection therapy, 131 Injuries, causing pain, 33 K Insomnia, 88 Institute for Healthcare Improvement, 160 Keywords searched, 282 Institute of Medicine (IOM), ix–x, 2, 20, 55, Knee replacement surgeries, 132 97, 194, 232, 243, 303 Knowledge. See Basic knowledge; Existing Committee on Care at the End of Life, knowledge; New knowledge 143 Korean conflict, 82 publications from, 23, 69, 199 Insurance coverage, a barrier to effective pain care, 148, 156, 298–299 L Insurance incentives, 148–150 Lasker, Mary, 244 Integrative approach, 126 Last Acts campaign, 188 Interagency Pain Research Coordinating Liaison Committee on Medical Education, 210 Committee, 7, 103, 269 Licensing physicians, 210 Interdisciplinary approaches, xi, 278. See also Life-cycle factors, associated with the Collaboration development of chronic pain, 30 need for, 3–4, 22, 42, 197–198, 227–228 Lifesaving, progress in, 63 teams using, 121–124 Limitations of clinical trials, initiatives to International Association for the Study of Pain address, 230–232 (IASP), 25, 47, 120, 205, 219, 239 Limitations on data, 59–61 International Covenant on Economic, Social, Listening skills, of physicians, 193–194 and Cultural Rights, 143 Literature review, 201, 282 Internet, education based on, 197, 252 Logistic regression, hourly wages models for Interstitial cystitis, 75, 137 selected pain conditions, 332–333 InterTribal Council of Arizona, Inc., 72 Longitudinal research, need for, 13, 60–61, Interviews. See Structured psychiatric 253 interview methods Low back pain Ion channels, 222 chronic, 63–64 Iraq conflicts, 81, 157–158 fiscal challenge of caring for, 148 Issues in pain care practice, 137–152 public education campaigns on, 97, access to opioid analgesics and concerns 185–186 about their use, 142–148 adequacy of pain control in hospitals and nursing homes, 140–141 M difficulties in measuring pain, 137–140 insurance incentives, 148–150 Magnitude of the problem, of effective pain pain and suffering at the end of life, care, 153 141–142 Management of pain. See Pain management; the reporting of pain, 150–152 Self-management of pain

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357 INDEX Massachusetts Pain Initiative, 190 MEDLINE, 282 Massage, 135 Mental health, impact of pain on, 31–32 Massage ultrasound, 134 Methodology. See also Data sources and Mayday Fund, 185, 189, 194, 246 methods; Structured psychiatric McGill University, Pain Genetics Lab, 36 interview methods Measuring pain for the economic costs of pain, 91–93, 302 difficulties in, 137–140 Migraine (Oliver Sacks), 191 and objectivity, xi–xii Migraine headaches, 87 “Mechanisms, Models, Measurement, and Mind-body separation, Cartesian model of, Management in Pain Research Funding 35, 154 Opportunity Announcement,” 240–241, Minimum Data Set, 83 259–267 Missed days models, for selected pain biobehavioral pain, 261 conditions, 328–329 diagnosis and assessment of pain, 262–263 Missed hours models, for selected pain epidemiology of pain, 264–265 conditions, 330–331 genetics of pain, 260 Misuse. See Medications for pain health disparities, 265–266 Models of pain, 262. See also Hourly wages models of pain, 262 models; Missed days models; Missed molecular and cellular mechanisms of hours models pain, 259–260 Models of pain care, 158–161. See also pain management, 263–264 Cost models for selected pain research objectives, 259 conditions; Health care expenditure translational pain research, 266–267 models; Indirect cost models; Quality Mechanisms of pain, molecular and cellular, improvement (QI) model 259–260 Department of Defense, 160 Medicaid, 5, 93, 98, 147 Department of Veterans Affairs, 158–160 low physician reimbursement rates in, 296 other models, 160–161 Medical and Osteopathic Practice Act (model), “Monitoring the Future,” 146 191 Moral imperative, treating pain as, 3, 22 Medical Care inflation index, of the Consumer Moral judgment, 46 Price Index (CPI), 302 Multidimensional Pain Inventory, 237 Medical Expenditure Panel Survey (MEPS), Multimodal efforts, public health support for, 61, 91, 302, 304–305, 307, 310 98–99 Medical expenditures, for selected pain Musculoskeletal pain, 81, 118, 314 conditions, average incremental costs of, 321 N Medical Product Safety Objectives, 57–58 Medical treatments, causing pain, 33 Nation, costs of pain and its treatment to, Medicare, 5, 93, 98, 150, 234 91–93 Medicare beneficiaries, joint replacement National Alliance on Mental Illness, 57 statistics among, 132 National Ambulatory Medical Care Survey, Medications causing pain, 130–131 130 Medications for pain, 20, 114, 120, 129–131. National Board of Medical Examiners, 193 See also Antianxiety medication National Cancer Institute (NCI), National abuse and misuse, 201 Cooperative Drug Discovery Group, insurance coverage for, 84 247 “off-label” uses of, 58 National Center for Advancing Translational prescribing for children, 77–78 Sciences, 240 Medicine. See Complementary and alternative National Center for Complementary and medicine Alternative Medicine, 134–135 Meditation, 132

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358 INDEX National Center for Health Statistics (NCHS), Need to improve, data sources and methods, 6, 6, 13, 61, 101, 254, 304 101–102, 123–124 National Committee for Quality Assurance, Nerve pathways, and the causes and Healthcare Effectiveness Data and persistence of pain, 38 Information Set, 149 Nervous system, malfunctioning, 225 National Cooperative Drug Discovery Group, Neuroimaging, to investigate pain, 38–40, 247 137, 223 National Data Bank for Rheumatic Diseases, Neuromatrix theory, 38, 278 234 Neuropathic pain, 33–34, 222, 278 National Fibromyalgia Association, 189 diabetic, 249 National Health and Nutrition Examination Neuropathy Association, The, 59 Survey (NHANES), 61, 63–64, 67, 70, New analgesics, difficulty of developing, 77, 129, 131 224–225 National Health Interview Survey (NHIS), 61, New England School of Acupuncture, 208 71, 86, 135, 303 New knowledge, 56 National Hospital Ambulatory Medical Care New Pathways to Discovery, 241 Survey, 130 New York Academy of Medicine, Grey National Institute for Nursing Research, 239 Literature database, 282 National Institute of Neurological Disorders NMDA receptor pathways, drugs acting on, and Stroke, 243, 251 300 National Institute on Aging, 189 Nociception, 36, 39, 68, 222, 278 National Institute on Alcohol Abuse and Nonsteroidal anti-inflammatory drugs, 225 Alcoholism, 240 Norway, public education campaign on low National Institute on Drug Abuse, 240 back pain, 186 National Institutes of Health (NIH), 12, 20, 56, Nurse Practitioner Healthcare Foundation, 92, 99, 189, 218–219, 245, 253, 313 201 Common Fund, 241 Nurses, 91, 201 National Center for Complementary and education of, 201–204 Alternative Medicine, 134 Nursing homes, adequacy of pain control in, Pain Consortium, 7, 11–12, 103, 190, 240, 69, 142 242–244, 251–252, 269–270 Roadmap for Medical Research, 237, 241 O National Institutes of Health Reform Act, 240 National Nursing Home Survey (NNHS), 82 Obesity, and pain, 63, 226 National Pain Management Strategy, 158 Objectives National Research Council, 303 regarding the economic costs of pain, 302 National Violent Death Reporting System of research, 259 (NVDRS), 89 Objectivity, x, 24. See also Measuring pain; Native Hawaiian Health Care Systems Subjectivity Program, 96 Observational studies, 234–236 Near-term goals, for transforming pain Occupational rank, influence on health, 74 prevention, care, education, and Occupational therapy. See Physical and research, 270, 273–275 occupational therapy Need for a cultural transformation, 44–49, “Off-label” uses, of drugs for pain, 58 209, 250–251 Office of Critical Path Programs, 231 the necessary cultural transformation, Opioid use, 36, 56, 278. See also Access to 47–49 opioid analgesics overview of barriers to improved pain care, the conundrum of, 3, 22, 144, 225 45–47 Opioids Risk Evaluation and Mitigation in the way pain is viewed and treated, 3–4 Strategy (REMS), 142–143

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359 INDEX Organization scope of the problem, 59–64 alternative, in research, 241–243 the seriousness of pain, 85–90 of the report, 49 Pain care Orofacial pain, 207. See also barriers to effective, 153–157 Temporomandibular joint (TMJ) bias in, xi disorders demand for, 190 Osteoarthritis, 79 evidence-based, 10, 164 Outcome Measures in Rheumatoid Arthritis issues in, 137–152 Clinical Trials (OMERACT), 231 need to individualize, 8, 100, 161–162, 236 Outcomes-based care, 298 Pain catastrophizing, 43, 88, 94, 278 Overtreating people with pain, 299 Pain centers, 9, 98, 116, 123–124, 159–160, Oxycodone, 130, 146 220 Pain Connection-Chronic Pain Outreach Center, Inc., 180 P Pain Consortium, 7, 11–12, 103, 190, 240, 242–244, 251–252, 269–270 Pain. See also Acute pain; Barriers to Pain diagnoses, 262–263 improving pain care; Chronic pain; total direct costs of medical care for, Economic costs of pain; Joint pain; 312–313 Low back pain; Musculoskeletal pain; uncertainty of, 4, 46 Neuropathic pain; Orofacial pain; Pain diaries, 238 Prevalence of pain; Referred pain; Pain Genetics Lab, 36 Seriousness of pain; Translational pain Pain in childhood, causes and persistence of, in animals, 223 37 causes and persistence of, 34–44 Pain management, xi, 263–264. See also Self- complexity of, 8, 24–26, 220 management of pain definitions of, 1, 24–26, 278 Pain Management Directive, 158 impact on physical and mental health, Pain management index, 68 31–32 Pain prevention, 95–98, 233 maladaptive coping strategies, 94 blueprint for transforming, 14–17, 269–275 the picture of, and risk, 27 examples of population-based initiatives, protection from and relief of, ix 97 romanticizing, ix importance of, 3–4, 22, 45 statistics on, 28 potential savings from improvements in, typology of, 32–34 100 universality of, 2, 19, 55–56 role of public health in, 95–98 as a warning, 24 “Pain pumps,” 131 Pain adjustment, assessment of states related Pain-related disability, 29, 117 to, 237–238 among adults with pain, extent of, 86 Pain and Palliative Medicine Specialty Section Pain Relief Ladder, 143 Council (of the AMA), 191 Pain Research, Informatics, Medical “Pain apathy,” 193 Comorbidities, and Education Center, Pain as a public health challenge, 55–111 242 the costs of pain and its treatment, 91–95 Pain Research Coordinating Committee, 240 data sources and limitations, 59–61 Pain Research Program, 242 disparities in prevalence and care in Pain Research Working Group, 242 selected populations, 64 Pain resource nurse (PRN) programs, 204 findings and recommendations, 100–103 Pain specialists, 8–10, 116 overall prevalence, 61–64 training and credentialing of physicians as, potential roles for public health, 95–100 198–201 present crisis in, xii Pain Summit, 219

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360 INDEX Pain tolerance, lower among African Physicians Americans, 67 with chronic pain, 190 PainCAS, 234 education of, 190–201 Palliative care, 85. See also Hospice patients listening skills of, 193–194 “Passport to Comfort,” 118 “medical story” each is telling, 193 Patient-Centered Outcomes Research Institute, promoting physicians’ understanding of 247 medication abuse and misuse, 201 Patient education, 180–184 training and credentialing of physician pain essential topics for, 182 specialists, 198–201 Patient Education Forum, 189 training of primary care physicians, Patient-level barriers, to improved pain care, 196–198 46–47 visits to, 19–20 Patient Protection and Affordable Care Act, who treat chronic pain, 32 20, 47, 248 Placebos, 228 Patient-Provider Agreements, 142 note on the use of for treating people with Patient Report Medical Outcomes Reporting pain, 136–137 System (PROMIS), 237, 242 Population-based prevention initiatives Patients. See also Access to opioid analgesics campaign to reduce back pain disability, with chronic pain, 19, 24, 26, 32, 59, 85, 74, 97 113, 142, 158, 179, 238, 293 examples of, 97 cultural attitudes of, 156–157 need for, 6–7 phenotyping, 223 Prescription Drug Take-Back programs, 97 roles for, 3, 22 suicide prevention, 97 written public testimony on experiences Posttraumatic stress disorder (PTSD), 81 seeking treatment for pain, 294 PPP Program, 247 Patrick and Catherine Weldon Donaghue Practice-based evidence (PBE), 235 Medical Research Foundation, 246 difficulty of developing new analgesics, Ped-IMMPACT, 231 224–225 Pediatric ED, analgesia in, 78 moving from research to, 224–228 Peripheral sensitization, 33 need for interdisciplinary approaches, Persian Gulf war, 82 227–228 Persistence of pain, 34–44 shortfalls in applying psychosocial the brain’s role, 38–40 approaches in practice, 226–227 and causes, 34–44 Prescriptions, 201. See also Electronic cognitive context, 42–44 prescription monitoring system the complexity of chronic pain, 34–36 getting filled, 157 emotional context, 40–42 of opioids, written public testimony on genetic influences, 36–37 difficulties surrounding, 297–298 nerve pathways, 38 President’s Commission on Care for America’s pain in childhood, 37 Returning Wounded Warriors, 81 Pharmacist, 129 Prevalence of pain, 9, 61–64 Pharmacokinetic data, 233 key shortcomings of data on, 60 Phenotyping, 223 rising, 5 Physical and occupational therapy trends in the United States, 64 education in, 207–208 Prevention of pain. See Pain prevention not covered by insurance, 296 Primary care physicians, 9, 116–117 rehabilitative, 133–134 education challenges of, 154–155, 163, Physical conditioning programs, 133 196–198 Physical health, impact of pain on, 31–32 first step for many patients, 8, 116, 150 Physician-patient communication, 68, 126, protocols to guide, 155–156 137, 152 shortage of, 148, 197

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361 INDEX Principles. See Underlying principles lowering costs for, 100 Problem-solving ability potential projects for, 248–250 deficits in, 88 Public understanding of pain, 63 of teams, 198 Productivity, effects of pain on, 86–87 Q Project STEP, 246 Projects for public–private partnerships, Quality improvement (QI) model, 160, 196 potential, 248–250 Quality of life, effects of pain on, xi, 87–88, Provider attitudes and training, a barrier to 139 effective pain care, 153–156 Quotations from pain sufferers, 19, 24, 26, 32, Psychiatric disorders, 265 59, 85, 113, 142, 158, 179, 190, 238, Psychological stressors, 37 293–300 as factors in pain, 25 Psychological therapies, for treating people with pain, 114, 132–133, 227 R Psychological traits, assessment of, 237–238 Psychology, education in, 204–206 Racial and ethnic factors, 66–73, 89–90 Psychosocial approaches African American, 67–70 assessment of dimensions of pain, 236–237 American Indians and Alaska Natives, assessment of psychological traits and 72–73 states related to pain adjustment, Asian Americans, 71–72 237–238 Hispanics, 70–71 ongoing assessment and monitoring of pain Randomized controlled trials (RCTs), and pain-related states, 238 228–230 opportunities in, 127, 133, 223 failures of, 229–230 research in, 220, 236–238 Recommendations and findings, 4–13, 100 shortfalls in applying in practice, audiences for, 23, 57 226–227 Reengineering the Clinical Research PsycINFO, 282 Enterprise, 241 Public education, 184–190 Referred pain, 35, 279 Public education campaigns on low back pain, Registries, 234–236 185–186 Regulatory barriers, to effective pain care, 157 Australia, 97, 185–186 “Regulatory science,” defined, 224 Canada, 186 Regulatory Science Initiative, 224 Norway, 186 Rehabilitation Institute of Washington, 161 Scotland, 186 Rehabilitative therapy, for treating people with Public health-based approach. See also Pain as pain, 114, 133–134 a public health challenge Reimbursement policies costs and savings from a public health inadequate, 10, 156, 226 approach, 100 need to revise, 10, 121, 164 other public health considerations, 99 written public testimony on, 298–299 potential roles for, 95–100 Reinecke, Peter, 239 public health defined, 55 Reinjury, fear of, 42 role in prevention, 95–98 Relaxation techniques, 132 support for multimodal efforts, 98–99 Religious judgment, 46 value of, 3 Report, organization of, 49 Public meetings, 282–291. See also Written Reporting of pain, 150–152 public testimony Research Public–private partnerships (PPPs), 243, blueprint for transforming, 14–17, 269–275 245–250 potential savings from improvements in, current, 245–248 100

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362 INDEX Research challenges, 56, 217–258 Restoration techniques, 134 Annex 5-1: Mechanisms, models, Richard, Patrick, 301–337 measurement, and management in Risk, 26–31 pain research funding opportunity Risk Evaluation and Mitigation Strategy announcement, 259–267 (REMS), approach to opioids, 142–143 biobehavioral pain, 261 Roadmap for Medical Research, 237, 241 building the research workforce, 238–239 New Pathways to Discovery, 241 diagnosis and assessment of pain, 262–263 Reengineering the Clinical Research epidemiology of pain, 264–265 Enterprise, 241 expanding basic knowledge, 220–223 Research Teams of the Future, 241 findings and recommendations, 250–254 Royal College of General Practitioners, 219 fostering public–private partnerships, 245–250 S genetics of pain, 260 health disparities, 265–266 Sacks, Oliver, 191 improving and diversifying research Sample, of the economic costs of pain, methods, 228–238 304–305 models of pain, 262 Saunders, Cecily, 139–141 molecular and cellular mechanisms of Savings from a public health approach, 100 pain, 259–260 Scientific Management Review Board moving from research to practice, 224–228 (SMRB), 240 need for longitudinal, 13 Scope of the problem of pain, 59–64 obtaining federal research funding, data sources and limitations, 59–61 244–245 overall prevalence, 61–64 organizational alternatives, 241–243 Scotland, public education campaign on low organizing research efforts, 239–243 back pain, 186 pain management, 263–264 Self-care, facilitation of, 4 research objectives, 259 Self-efficacy, 44, 279 a road not taken, 239–241 Self-management of pain, 8, 44, 114, 116–117 translational pain research, 266–267 promoting and enabling, 162, 227 Research methods Self-reporting of pain, 236 comparative effectiveness research, Sensitivity, declining in the elderly, 79 observational studies, and Sensitization, 33, 36, 279 psychological research, 232–234 Seriousness of pain, 85–90 improving and diversifying, 228–238 differences in the seriousness of pain by initiatives to address limitations of clinical race/ethnicity and sex, 89–90 trials, 230–232 effects on activities of daily living, 86 observational studies, databases, and effects on productivity, 86–87 registries, 234–236 effects on quality of life, 87–88 psychosocial research, 236–238 effects on the risk of suicide, 88–89 randomized controlled trials: the gold Serotonin, 40 standard, 229–230 Sex Research results, 303, 309–313 differences in the seriousness of pain by, incremental costs of health care, 309–311 89–90 indirect costs of health care, 311–312 disparities in prevalence and care by, total direct cost for medical care for pain 75–77 diagnoses, 312–313 Shingles, 79 Research Teams of the Future, 241 Shoulder replacement surgeries, 132 Research workforce Sickle-cell disease, pain associated with, 122, building, 238–239 295 increasing training of, 13

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363 INDEX Sleep disorders, 88 Tockarshewsky, Tina, 59 Social factors in pain, 25 Tolerance. See Pain tolerance Socioeconomic status, chronic pain inversely Training of primary care physicians, 196–198 related to, 74–75 inadequate, 194 Sources “leading to competency,” 191–192 of acute pain, common, 29 provider attitudes and, 153–156 of chronic pain, common, 29 Transcutaneous electrical nerve stimulation of data, methods and, 281–291 (TENS), 134 Spinal manipulation, 135 Transforming education, x–xi St. Jude’s Children’s Research Hospital, 160 blueprint for, 14–17, 269–275 Statistics on pain, 28 Transient receptor potential (TRP) ion Stem cells, 222 channels, 222 Steps in care, 115–124 Transition, from acute to chronic pain, 29–31 Stereotyping, 78 Translational pain, research in, 266–267 Stigma against pain, 4, 46 Treatment. See also Overtreating people with Stoicism, “deeply-rooted value and belief in,” pain 71 access to pain care, 127–128 Structural neuroimaging, to investigate pain, value of comprehensive, 3, 22 39 written public testimony on lack of timely, Structured psychiatric interview methods, 237 296 Subgroups. See Undertreated groups Treatment modalities for pain, 129–137 Subjectivity, of the experience of pain, 25, 223 choice of a treatment approach, 124–127 Substance Abuse and Mental Health Services complementary and alternative medicine, Administration (SAMHSA), 99, 134–136 145–146 measuring effectiveness of, 192, 227 Substance P antagonists, 300 medications, 129–131 Suffering, protection from and relief of, ix note on the use of placebos, 136–137 Suicide, effects of pain on the risk of, 88–89 overview, 115 Surgeon General, Office of, 56, 189 psychological therapies, 132–133 Surgery, for treating people with pain, 68, 114, regional anesthetic interventions, 131 131–132 rehabilitative/physical therapy, 133–134 Surgical patients, 63 steps in care, 115–124 disparities in prevalence and care for, surgery, 131–132 83–84 written public testimony on the need for Survey overview, 294 new, 300 System-level barriers, to improved pain care, TRICARE, 5, 93 45 Truman, Harry S, 269 Tufts University School of Medicine, 208 Typology of pain, 32–34 T Teams, using interdisciplinary approaches, U 121–124 Telephone survey, American Productivity U.K. Department of Health, Chronic Pain Audit, 86 Policy Coalition, 219 Temporomandibular joint (TMJ) disorders, U.N. Single Convention on Narcotic Drugs, 75, 207 143 Terminal illnesses. See End of life Underlying principles, 3, 20–23 Tissue healing, pain persisting after, 35 chronic pain as a disease in itself, 3, 22 TMJ Association, Ltd., 184, 217, 224 the conundrum of opioids, 3, 22 Tobacco use, campaigns to reduce, 187 importance of prevention, 3, 22

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364 INDEX a moral imperative, 3, 22 White House comprehensive action plan on need for interdisciplinary approaches, 3, 22 prescription drug abuse, 142 roles for patients and clinicians, 3, 22 Women with Pain Coalition, 189 value of a public health and community- Work disability, 20 based approach, 3 days missed because of selected pain value of comprehensive treatment, 3, 22 conditions, 325, 334 wider use of existing knowledge, 3, 22 hours lost due to selected pain conditions, Undertreated groups, 55, 68 335 written public testimony on, 294 Workers’ Compensation, 5, 69, 93, 296 Workers’ Compensation database, 304 Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 69 World Health Organization (WHO), 47 United Council for Neurologic Subspecialties Constitution, 47 (UCNS), 199 Pain Relief Ladder, 143 University of New Mexico Project ECHO Pain World War II, 82 Clinic, 161 WorldCat, 282 Unknown causes of pain, 34 Written public testimony, 293–300 Urban Indian Health Program (UIHP), 72 conclusion, 300 U.S. Bureau of the Census, 303 difficulties surrounding prescription of U.S. Medical Licensing Examination, 210 opioids, 297–298 economic burden, 296 the impact of pain, 295 V lack of timely treatment, 296 need for new treatments, 300 Variables, in the economic costs of pain, Q1: on barriers to pain care, 294 305–307 Q2: on improving pain care, 294 Veterans. See also Department of Defense; Q3: on undertreated groups, 294 Department of Veterans Affairs Q4: on experiences seeking treatment for disparities in prevalence and care for pain, 294 military, 80–82 Q5: on experiences providing pain Veterinary science, 223 treatment, 294 Vicodin, 146 Q6: additional comments, 294 Vietnam war, 82 reimbursement policies, 298–299 Von Roenn, J. H., et al., 44 summary of, 293–300 Vulnerable populations, 5, 55, 65, 76, 99 Vulvodynia, 75, 137 W Wages. See Hourly wage reductions Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and function scale, 231, 237