Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

Chronic pain affects about 100 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity.

The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. Acting through the National Institutes of Health (NIH), HHS asked the IOM to assess the state of the science regarding pain research, care, and education and to make recommendations to advance the field.

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research presents the IOM study committee’s findings and recommendations.

Fostering a Cultural Transformation

Pain represents a national challenge. A cultural transformation is necessary to better prevent, assess, treat, and understand pain of all types.

Government agencies, healthcare providers, healthcare professional associations, educators, and public and private funders of health care should take the lead in this transformation. Patient advocacy groups also should engage their diverse constituencies. This report provides a blueprint for achieving this transformation.

Pain as a Public Health Challenge

To reach the vast multitude of people with various types of pain, the nation must adopt a population- level prevention and management strategy. HHS should develop a comprehensive plan with specific goals, actions, and timeframes. The plan should:

• heighten awareness about pain and its health consequences;
• emphasize the prevention of pain;
• improve pain assessment and management in the delivery of healthcare and financing programs of the federal government;
• use public health communication strategies to inform patients on how to manage their own pain; and
• address disparities in the experience of pain among subgroups of Americans.

Better data are needed to help shape efforts. Although pain is known to be prevalent across society, reliable data are lacking on the full scope of the problem, especially among those currently underdiagnosed and undertreated, including racial and ethnic minorities; people with lower levels of income and education; women, children, and older people; military veterans; surgery and cancer patients; and people at the end of life; among others. Therefore, the National Center for Health Statistics, Agency for Healthcare Research and Quality (AHRQ), other federal and state agencies, and private organizations should accelerate the collection of data on pain incidence, prevalence, and treatments. Data should be collected at regular intervals using standardized questions, protocols for surveys, and electronic medical records to identify the following information:

• subpopulations at risk;
• characteristics of acute and chronic pain;
• profound health consequences of pain, including death, disease, and disability; and
• related trends over time.

Care of People with Pain

People with pain receive care in various ways, including assistance with self-management, primary care, specialty care, and pain clinics, among others. Treatments can include medications, surgery, behavioral interventions, psychological counseling, rehabilitative and physical therapy, and complementary and alternative therapies. For many people, however, pain prevention, assessment, and treatment are inadequate.

Among steps to improving care, healthcare providers should increasingly aim at tailoring pain care to each person’s experience, and selfmanagement of pain should be promoted. Also, primary care physicians—who handle most frontline pain care—should collaborate with pain specialists in cases where pain persists. Public and private insurers can help by offering incentives to support the delivery by primary care providers of coordinated, evidence-based, interdisciplinary pain assessment and care for persons with complex pain.

A number of barriers—including regulatory, legal, institutional, financial, and geographical barriers—limit the availability of pain care and contribute to the disparities found among some groups. Government agencies, healthcare providers, and public and private funders of health care should adopt a comprehensive, strategic approach to reduce or eliminate these barriers.

 

Revised March 2012