Transforming the Way Chronic Pain Is Treated

Every year, at least 116 million adults in the United States experience chronic pain, a condition that is often preventable or could be better managed, according to a new report from the Institute of Medicine.

The report calls for coordinated, national efforts to create a cultural transformation in how the nation understands and approaches pain management and prevention.

"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," said committee chair Philip Pizzo, MD, of Stanford University School of Medicine. "All too often, prevention and treatment of pain are delayed, inaccessible, or inadequate. Patients, health care providers, and our society need to overcome misperceptions and biases about pain. We have effective tools and services to tackle the many factors that influence pain and we need to apply them expeditiously through an integrated approach tailored to each patient."

A new analysis undertaken as part of the study finds that the medical costs of pain care and the economic costs related to disability days and lost wages and productivity amount to at least $560 billion to $635 billion annually. Because the range does not include costs associated with pain in children or military personnel, it is believed to be a conservative estimate.

The report emphasized that although pain is universal, it is experienced uniquely by each person, and treatment—which often requires a combination of therapies and coping techniques—must be tailored. It also pointed out the following:

• 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.
• Individuals’ experience of pain can be influenced by genes, cultural attitudes toward hardships, stress, depression, ability to understand health information, and other behavioral, cultural, and emotional factors.
• Successful treatment, management, and prevention of pain requires an integrated, approach that responds to all the factors that influence pain.
• The majority of care and management should take place through primary care providers and patient self-management with specialty care services reserved for more complex cases. Health care organizations should take the lead in developing innovative approaches and materials to coach and empower patients in self-management.
• Training programs for dentists, nurses, physicians, psychologists, and other health professionals should include pain education in their curricula and promote interdisciplinary learning. Many health care professionals are not adequately prepared to provide the full range of pain care or to guide patients in self-managing chronic pain.
• Programs that train specialists or offer training in advanced pain care need to be expanded.

Finally, the report calls on Medicare, Medicaid, workers' compensation programs, and private health plans to find ways to cover interdisciplinary pain care. Individualized care requires adequate time to counsel patients and families, consultation with multiple providers including pharmacists, and often more than one form of therapy. Current reimbursement systems, however, are not designed to efficiently pay for this kind of approach and health care organizations are not set up for integrated patient management.

To access the report, click here.