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Fall 2011 Vol. 11 Number 2

Table of Contents

Relieving America’s Crisis of Pain

©FotosearchPain is universal, yet every person experiences it uniquely. It presents one of the most complex problems faced by health care professionals.

Even though pain arises as a symptom of many conditions, health professionals receive relatively little training in pain management as they learn to deal with organs, bones, or the brain’s inner workings. There is no blood test or other yardstick to objectively measure pain, and different individuals can react to the same stimulus very differently. Only recently has research revealed how pain can rewire the nervous system and persist even after the initial cause is resolved. The difficulties of controlling addiction to and abuse of powerful pain medications add yet another layer of complexity.

Health care providers and the public are hardly in a position to ignore or downplay these challenges, but a review by the Institute of Medicine suggests that it happens all too often. Underdiagnosed and undertreated, chronic pain amounts to an unrecognized public health crisis afflicting more than 116 million adult Americans each year and costing the nation $560 billion to $635 billion annually in medical and economic expenses, says the IOM’s report.

The report offers an integrated approach to pain treatment, management, and prevention that would respond to all the factors that influence pain. To start, training programs for health professionals need to include pain education in their curricula. Only five of the nation’s 133 medical schools require students to take pain courses and just 17 offer such classes as electives. Medical licensing and certification exams should include assessment of pain-related knowledge. Programs that train specialists or offer training in advanced pain care need to be expanded given the relatively small number of specialists.

The majority of pain care 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 patients in pain management.

In addition, health insurance plans need to cover interdisciplinary pain care. Individualized care requires time to counsel patients and families, consultation with multiple providers, and often more than one form of therapy. Current reimbursement systems are not designed to efficiently pay for this kind of multipronged approach.

Pain is a major driver for medication consumption, doctor visits, and disability. The IOM’s report lays out the case for why and how it can be better managed. -- Christine Stencel

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Committee on Advancing Pain Research, Care, and Education, Board on Health Sciences Policy, Institute of Medicine (2011, 382 pp.; ISBN 0-309-21484-X; available from the National Academies Press, tel. 1-800-624-6242; $59.95 plus $5.00 shipping for single copies).

The committee was chaired by Philip Pizzo, dean, Carl and Elizabeth Naumann Professor of Pediatrics, and professor of microbiology and immunology, Stanford University School of Medicine, Stanford, Calif. The study was funded by the National Institutes of Health.

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Copyright 2011 by the National Academy of Sciences