Publications
APS Bulletin • Volume 14, Number 5, 2004
President’s Message
Progress and Directions for the Agenda for Pain Management
Dennis C. Turk, PhD
Public Awareness
APS developed a public service radio announcement that was distributed widely. As a follow-up, during the past year, APS began distributing a weekly news release of The Pain Care Minute. Each week a 60-second story highlighting some facet on pain and pain management is distributed. Of course, no topic can be covered in depth in such a brief snapshot but the intent is to learn from advertising—namely that repetition is essential to branding, or establishing recognition. In each segment, the APS Web site is mentioned, encouraging professionals to log on.
Partners for Understanding Pain brought together a coalition of groups to sponsor September as Pain Awareness Month. This coalition has developed materials for local, regional, and national distribution to generate interest in pain and pain management for the lay public but also for professionals (to learn more about the coalition log on to www.understandingpain.org).
APS created the Kathleen M. Foley Journalism Award to acknowledge the contribution of a journalist for a story or series addressing important pain-related topics and to bring attention to the area by encouraging journalists to seek out and to present stories that make pain real, by emphasizing issues to the lay public, as well as policy and decision makers.
Some of the challenges for public awareness include greater acknowledgment of the existing disparities related to age, race, ethnicity, socioeconomic status, and health insurance coverage. It is important that pain professionals move beyond mere recognition of the sources of disparities to begin to address ways to alleviate them. Greater efforts are also needed to address these pain misconceptions to educate the public about their rights to appropriate care but also to educate them about their responsibilities for self-management and adherence to recommendations.
Professional Awareness
There has been significant growth in the attendance at national and regional meetings dedicated to various aspects of pain. There has also been a proliferation of professional and consumer advocacy organizations devoted to pain and pain management and specific diagnostic groups where pain is a central component devoted to particular treatment modalities. There is of course a concern about fragmentation; however, coalitions and collaboration will increase the potency of messages surrounding the common concern about pain. Although preceding the decade, there has been continued growth in recognition and board certification in pain medicine by the American Board of Medical Specialties and the American Academy of Pain Medicine throughout the decade.
APS continues to publish its popular Analgesic Guides and its highly respected evidenced-based Clinical Practice Guidelines series. In the next few months two additional guidelines will be published, one on cancer-related pain and a second on fibromyalgia syndrome. A summary of the fibromyalgia-syndrome guideline has already been accepted for publication in the Journal of the American Medical Association (Goldenberg, Burchkardt, & Crofford, in press). APS, in collaboration with one of our regional chapters, Greater Philadelphia Pain Society, is completing a brief volume on pain assessment and management for primary care physicians. The publication of these documents provides valuable guidance for healthcare providers in the appropriate assessment and treatment of people with pain in general and pain associated with specific diseases and syndromes.
Despite the accomplishments to date, significant challenges remain. The emphasis on pain management remains clustered in relatively few medical specialties (e.g., anesthesiology, neurology, oncology) but is given much less attention in cardiology, gastroenterology, urology, gynecology, and pediatrics to name a few. Ways to transfer the numerous advances in pain management to these under-enlightened specialties must be found. A reality that must be acknowledged is that the majority of pain management is conducted in primary care. Strategies need to be developed and energy expended to provide appropriate education to those on the front lines of pain management who do not usually attend conferences on pain or read pain-specific journals.
Public Policy
Both the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Veterans Health Administration have adopted Pain as the 5th Vital Sign. This initiative mandates that pain be taken seriously and assessed adequately and treated in the majority of hospitals and clinics nationwide.
Although there has been tension between those who prescribe opioids and the DEA, recently a consensus document was jointly released on the uses and abuses of prescription pain medication. In addition, the Federation of State Medical Boards passed a model policy on the use of controlled substances to treat pain. These documents should reduce some of the confusion and adversarial relationship among these groups and provide guidance to prescribers to reduce problems.
In the state of California, Assembly Bill (AB) 487 was passed mandating that 12 CMEs on pain and palliative care must be obtained for renewal of medical licensure. Several other state governments are considering similar requirements for physicians but also for other health care providers.
In a recent, exciting development, the Mayday Fund staff has created an innovative Pain and Society Fellowship Program to provide advocacy training for healthcare providers and scholars to represent pain issues in policy and media arenas. In the first year of this program, an interdisciplinary group of six people has been accepted into it. APS members are particularly well represented.
The proposal of HR 1863, the Pain Care Policy Act (Rogers Bill) in the U.S. House of Representatives will make pain care research, education, and treatment a priority in federally funded healthcare programs and facilities. This is landmark legislation. Several important features of the Bill are worth enumerating, including the following: (a) the establishment of a White House conference on pain care to increase public awareness, assess the adequacy of pain care, and to identify barriers to pain care; (b) the authorization of a National Center for Pain and Palliative Care Research within the National Institutes of Health (NIH); (c) establishment of a Pain and Palliative Care Research and Quality Program within the Agency for Healthcare Research and Quality; (d) authorization to ensure that patients enrolled in Medicare managed care plans receive appropriate pain care; (e) authorization of a public awareness campaign by the U.S. Department of Health and Human Services (DHHS) to educate the public about appropriate pain care.
Perhaps the greatest obstacle to appropriate pain management is the lack of understanding of the third-party payers who refuse to cover many treatments with known beneficial effects to reduce pain and disability. In the same way that the adversarial relationship between the DEA and healthcare providers has hindered appropriate pain management, similar adversarial interactions with third-party payers impede efforts to provide optimal care. Greater collaboration is required among professional groups, consumers of healthcare services, governmental agencies, and third-party payers to ensure that the most clinically effective and cost-effective treatments are provided to all likely to benefit from them.
Research
NIH reconstituted the Pain Consortium to bring together representatives from the various institutes to address research needs related to pain and pain management. To learn more about this initiative, log on to the Web site painconsortium.nih.gov.Innovative research on the genetics, neurobiology, epidemiology, and treatment of pain is proliferating, as demonstrated by the research presented at the annual APS scientific meeting, as well as other organizations. The Journal of Pain has expanded the number of pages and issues published to accommodate the numbers of studies that are advancing the field and hold promise for improving pain management.
Pain accounts for more than 20% of medical visits and 10% of prescription drug sales but only .6% of NIH research funding. Policy and decision makers must be alerted to this imbalance to increase funding for pain research relative to its importance in human suffering and societal costs. Although there have been tremendous advances in scientific knowledge about the mechanisms involved in nociception and pain, the transfer of this knowledge into advanced treatments and clinical practice that results in improved quality of life of pain sufferers is inadequate. More attention needs to be devoted to translational research—research that moves from the laboratory to the clinic, from the bench to the bedside.
Reference
Goldenberg, D.L., Burchkardt, C., & Crofford, L.J. (in press). Management of fibromyalgia syndrome. Journal of the American Medical Association, in press.
Dennis C. Turk, PhD, is the John and Emma Bonica Professor of Anesthesiology and Pain Research in the Department of Anesthesiology at the University of Washington in Seattle, e-mail turkdc@u.washington.edu