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Pain Awareness Month: More Questions Than Answers

Creating wholesale changes in the way thousands of doctors interact with millions of patients is no small feat. But as the National Pain Strategy points out, we have a moral obligation to do this better.
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According to the American Chronic Pain Association (ACPA), September was anointed Pain Awareness Month in 2001 "to raise awareness in the issue of pain and pain management," with a goal of creating "greater understanding among health care individuals, individuals and families who are struggling with pain management, the business community, legislators, and the general public that pain is a serious public health issue." I think it is safe to say that over the last 14 years a lot of success has been achieved in building awareness about chronic pain and the enormous shadow it casts on the lives of patients, their families, and communities. Greater public awareness has come through the hard work of many activists and organizations like the ACPA, but unfortunately, a lot of the publicity surrounding pain over the last few years has come about over concerns surrounding the use, misuse, and abuse of prescription pain killers.

In 2015, we need a lot more than awareness. What we really need are tangible, measurable, and impactful solutions for millions of Americans who are hurting and suffering. Unfortunately, for health care providers and their patients, when it comes to pain treatment, there are often more questions than answers. If there is one lesson we have learned over the last 14 years, it is that we won't solve America's pain crisis by just throwing more drugs at it.

Perhaps no health problem in America is in bigger need of an infusion of quality care right now than the treatment of pain. With an estimated annual cost of around $600 billion in treatment and lost productivity, we spend more on pain than we do treating cancer, heart disease, or diabetes, but we don't seem to be getting a great return on our investments. The burden of chronic pain on our medical and disability systems remains high and unfortunately only seems to be getting worse.

Alarmed by our country's struggles to effectively treat pain, Congress mandated for a study to take place, and in 2010 the National Institute of Health contracted with the Institute of Medicine to perform a comprehensive assessment with recommendations. The Institute's 2011 eye opening results brought to light the enormity of the problem as well as the lack of consistently good answers for treatment. The study authors called for a "cultural transformation" in how our country goes about studying, assessing and treating pain.

More recently a follow up report has been released, titled the National Pain Strategy, released by the Interagency Pain Relief Coordinating Committee (IPRCC) at the charge of the Assistant Secretary for Health which falls under the U.S. Department of Health and Human Services (HHS).
While the National Pain Strategy is bold in its scope and may seem overwhelming to those in the trenches who treat pain, it offers promise and hope for an estimated 100 million Americans struggling with pain on a regular basis. The report is lengthy and comprehensive, and it raises many good discussion points for patients, doctors, and insurance companies. The full report can be found here.

Here are a few key take home points worth highlighting:

• The report introduces the concept of high-impact chronic pain. While a large proportion of the population may experience some level of daily pain, a certain subset experiences pain to the degree that they can't function well at work or at home, and even their ability to interact with others is limited. This high-impact group would be expected to require a considerable amount of assistance and treatment. Being able to better identify this group may help streamline the delivery of effective treatment.
• The importance of a more comprehensive, integrated, and interdisciplinary model of care is made clear throughout the report. The committee recognizes that a major lack of access to such programs along with our concurrent over-dependence on more unimodal therapies like pharmaceuticals and risky invasive treatments is a huge problem that must be addressed. They rightfully point out that a major barrier to providing more comprehensive treatments is a lack of necessary insurance coverage and its dependence on the old fee for service payment system. Physician behavior can't change without an economic system in place to facilitate providing better care to patients.
• The committee wants to emphasize the need for self-management programs. We know that coming up with ways to help pain patients learn valuable tools to effectively self-manage their pain improves their quality of life, reduces pain, and lightens the load on healthcare and disability systems. Making this an important feature of better pain management across the country is an excellent idea.
• The report also brings up the concept of prevention at a number of different levels. This includes studying ways to prevent injuries or diseases from happening in the first place, as well as designing strategies to curtail acute pain problems from progressing into chronic ones.
• The role of the primary care physician also gets a lot of attention. Many simply don't have the training and expertise to assess more complex chronic pain problems, nor do they typically have the resources at their disposal to provide effective treatment. Primary care doctors need a lot of help and support to better serve their patients in pain.

Creating wholesale changes in the way thousands of doctors interact with millions of patients is no small feat. But as the National Pain Strategy points out, we have a moral obligation to do this better.