The National Pain Strategy: A Vision

(Excerpt from the 2015 draft National Pain Strategy)

National Pain Strategy

If the objectives of the National Pain Strategy are achieved, the nation would see a decrease in prevalence across the continuum of pain, from acute, to chronic, to high-impact chronic pain, and across the life span from pediatric through geriatric populations, to end of life, which would reduce the burden of pain for individuals, families, and society as a whole. Americans experiencing pain—across this broad continuum —would have timely access to a care system that meets their biopsychosocial needs and takes into account individual preferences, risks, and social contexts. In other words, they would receive patient-centered care.

Further, Americans in general would recognize chronic pain as a complex disease and a threat to public health and to a just and productive society. Because of this greater understanding, significant public resources would be invested in the areas of preventing pain, creating access to evidence-based and high-quality pain assessment and treatment services and improving self-management abilities among those with pain. In addition, individuals who live with chronic pain would be viewed and treated with compassion and respect. Specifically, substantial progress in the care system would be achieved as follows:

Americans in general would recognize chronic pain as a complex disease and a threat to public health and to a just and productive society. Significant public resources would be invested in the areas of preventing pain, creating access to evidence-based and high-quality pain assessment and treatment services and improving self-management abilities among those with pain. Individuals who live with chronic pain would be viewed and treated with compassion and respect. Specifically, substantial progress in the care system would be achieved as follows:

  • Clinicians would take active prevention measures to prevent the progression of acute to chronic pain and its associated disabilities.
  • Clinicians would undertake comprehensive assessments of patients with chronic pain, leading to an integrated plan of coordinated care, managed by an interdisciplinary team, when needed. Treatment would involve high-quality, state-of-the-art, multimodal, evidence-based practices.
  • People with all levels of pain would have access to educational materials and effective approaches for self-care and pain self-management programs that would help them prevent, cope with, and reduce pain and its disability, and they would have better information about the benefits and risks of pain management options.

All Americans would be assured of obtaining preventive, assessment, treatment, and self-care interventions and support without bias, discrimination, or stigma.

 

National Library of Medicine

Interventional Pain Medicine: Retreat from the Biopsychosocial Model of Pain

By Randy S. Roth, PhD; Michael E. Geisser, PhD; and David A. Williams, PhD
        (Published online in Translational Behavioral Medicine on November 16, 2011)

Health-Body, Mind, Social

INTRODUCTION:

The biopsychosocial model (BPSM) serves as a theoretical foundation for the application of multidisciplinary approaches to illness management across many medical conditions. The field of pain management has benefitted greatly from its inclusion within this model [1].… Integrative and multidisciplinary pain programs combine a variety of therapeutic modalities including physical and occupational therapies, psychological interventions, and medical services in order to address the many clinical factors that can influence pain. A multidisciplinary approach places primary emphasis on pain management (rather than cure) and improved function (rather than pain relief) [7, 8]. Three decades of research has consistently documented the therapeutic superiority of multidisciplinary pain treatment compared to less comprehensive therapies or single-modality interventions [9–12].…

In this review, we will examine the conceptual and clinical issues that reflect the failure of IPM, in its most general form, as an independent pain practice. We will argue that IPM is out of step with both the modern biopsychosocial view of pain and current understandings of basic mechanisms associated with pain processing. We will devote particular attention to the importance of maladaptive pain beliefs and pain coping strategies as powerful moderators of the pain experience. By excluding these variables when considering candidacy for nerve blockade, IPM treatment outcomes are potentially compromised or subverted. We will also consider the impact of a procedurally oriented pain practice on the physician–patient relationship and discuss how the nature of this relationship can inadvertently reinforce maladaptive pain beliefs or undermine effective pain coping strategies being adopted by the patient.


Read the full article free at PubMed Central® through the U.S. National Institutes of Health’s National Library of Medicine.

 

How the CPC Can Help Meet the Objectives of the National Pain Strategy

Poised to meet the objectives of the 2015 draft of the National Pain Strategy (NPS) developed by the National Institutes of Health, the Community Pain Center (CPC) can help create the integrative, multimodal, patient-centric model of health care delivery that is envisioned. The NPS is the long-awaited response by the federal government to the 2011 Institute of Medicine Report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, which called for “a comprehensive, population health-level strategy for pain prevention, treatment, management, education, reimbursement, and research that includes specific goals, actions, timeframes, and resources.”

Community Pain Center Logo

Six sets of objectives … and … how the CPC will be able to assist the health care system in
meeting those objectives.
  • Population research: Through HIPAA-compliant self-management programs, surveys and trackers, participants are part of a “living laboratory” as they volunteer health information to contribute to scientific research. The CPC is a direct line to a large and diverse group of chronic pain patients who are eager to share their experience.
  • Prevention and care: The CPC’s focus on self-management includes using tools and resources that can help prevent, reduce and cope with pain. Research has shown improved health outcomes for patients using online self-management programs to treat chronic pain conditions.
  • Disparities: CPC articles, videos, forums, and many other resources are free, so anyone can benefit from these tools. The site has something for everyone: individuals, caregivers, medical professionals, nonprofit organizations (NPOs) and industry. A unified effort among these groups can improve the pain care model to reach the under-served patient population.
  • Service delivery and reimbursement: The CPC is designed to assist patients, caregivers and health care providers in creating personalized care plans. This patient-centric approach is evidence-based, integrative, interdisciplinary and multimodal in nature, and utilizes technology intended for time and cost savings, improved access to care, and better health outcomes.
  • Professional education and training: In partnership with NPOs and medical educators, the CPC will create continuing medical education programs to be administered in person or through an online portal. The CPC will also assist in the adoption of better pain education in medical school curricula. Additionally, CPC advocacy efforts, incorporating patient leaders and NPOs, will be a strong voice requesting NIH funding for more pain research.
  • Public education and communication: In order to raise awareness and help reduce the stigma associated with chronic pain, the CPC is active in educating the public through evidence-based information, as well as individual experiences, in order to inspire compassion for those with chronic pain. The CPC is also involved in promoting the safe use of prescription medications and is working with its partners to develop tools and resources for this purpose.
 

Huffington Post

How Digital Technology Can Personalize Health Care

By Ralph Snyderman, MD
         (Excerpt of Huffington Post article published on February 15, 2013)

A major flaw in health care today is that it’s focused on treatment of disease events after they develop rather than on preventing them. This approach is partly responsible for the massive increase in preventable chronic diseases. Digitalizing today’s “fix what’s broken” approach to health care would be akin to adding GPS to a horse and buggy. While improved technologies can enhance the effectiveness of treating disease events, the real opportunity lies in using them to create a new approach to care that enables individuals to improve their health, diminish their chance to develop preventable diseases, and minimize the consequences of diseases if they occur. A more rational model of care is within our grasp, and digitalization can make it far more effective. This approach is termed personalized health care.

Digital Health Care

Personalized health care on a digital platform can reconstruct our current expensive and inefficient sick-care approach into a cost-effective, health-enhancing system with individuals at the center of their care. While the practice of personalized health care is in its infancy, Obamacare is encouraging its adoption through reimbursement for preventive care and financial incentives for better outcomes, rather than more procedures. Importantly, as technologies enable individuals to become more informed and empowered about health care, they will be a major force for insisting on care that is designed to improve their health personally.


Read the full article at the Huffington Post.

 

National Pain Strategy PAINS Collaborators Meeting Recap

By Barby Ingle, Power of Pain Foundation President

On June 29 and 30, 2015, the Pain Action Alliance to Implement a National Strategy (PAINS), a group of over 100 pain collaborators and stakeholders, came together in Washington DC to discuss the National Pain Strategy (NPS). The purpose was to provide attendees an opportunity to discuss the NPS and find areas of agreement on next steps, collaborations, priorities, and to hold accountable those responsible for implementation.

Capitol Building in Washington DC USA

As the president of the Power of Pain Foundation, I was invited to participate. I went into the meeting with some preconceived notions based on little happening since the Institute of Medicine’s report in 2011 and didn’t expect much to be accomplished. To my great surprise, the meeting exceeded my expectations. I left the meeting feeling that a path toward implementation of stronger access to care issues was clarified as a result of the meeting. I am excited to be one of the attendees present that will be helping move a chronic pain agenda forward, making a difference in the lives of those living with pain.

The goals of the meeting were to encourage collaboration among key pain community leaders, to promote the NPS report and build enthusiasm for it, and to facilitate conversations about how to move forward to implementation of the strategy outlined in the report.

For me, the meeting clarified the path ahead for the NPS in terms of priorities,
implementation, next steps, funding,
leadership and accountability.

One of the unintended outcomes from the meeting was the consensus to support the messaging of the Chronic Pain Advocacy Task Force (CPATF). The CPATF is a group of 17 consumer advocacy groups convened by the State Pain Policy Action Network (SPPAN), which is a program of the American Academy of Pain Management (AAPM). As a founding member of the CPATF and the representative of one of the 17 groups involved, I was very proud to see that our work was recognized by this larger group of collaborators and stakeholders.

As agreed upon, the core messages are:

  1. Chronic pain is a real and complex disease that may exist by itself or be linked with other medical conditions.
  2. Chronic pain is both an under-recognized and under-resourced public health crisis with devastating personal and economic impact.
  3. Effective chronic pain care requires access to a wide range of treatment options, including biomedical, behavioral health and complementary treatment.
  4. Denying appropriate care to people with chronic pain is unethical and can lead to unnecessary suffering, depression, disability, and even suicide.

Not only has HHS been asked to include the core messages into the final version of the NPS report, but also over 50 more organizations and pain leaders have signed on to support these same core messages. I was not the only person who felt more confident leaving the meeting than when I arrived. Almost 94% of attendees who completed a post-event survey say that they felt more positive about the report than they had before the meeting.

I hope that the promise of access to timely and proper care and collaboration created in this NPS meeting pays off and helps policy makers see the importance of making chronic pain a high priority issue for society.

I know that together, we are making a difference. We are creating a platform that allows patients to share their stories and get involved. This empowers us to achieve better access to care through a stronger pain community.

The meeting was very well attended with collaborators from pain non-profits, the pharmaceutical industry, and professional societies, as well as patients and providers, and those directly connected as writers of the National Pain Strategy who are charged with oversight of its implementation. Presenters included Dr. Sean Mackey (the Co-Chair of the NPS Oversight Committee) and Amy Goldstein (director of the AAPM’s SPPAN), who were well informed and help set a tone that allowed for discussion of complex issues in a nonjudgmental way. All attendees were given the opportunity to raise questions and thought-provoking comments throughout the two day experience.
Government Committee Meeting
We were split up into six separate work groups to really delve into the different aspects of the NPS report (population research, prevention and care, disparities, service delivery and reimbursement, professional education and training, public education and communication). I served on the public education and communication subgroup committee. After our work group session we came back together and shared key components and goals our subgroups came up with for each area. Breaking it down in this manner led me to a sense of commitment, movement and wanting to take action to be one of those leaders who makes a difference in a meaningful way.

For me, the meeting clarified the path ahead for the NPS in terms of priorities, implementation, next steps, funding, leadership and accountability. The Power of Pain Foundation will be including many of the aspects and messaging in our upcoming projects for 2016-2017. I hope that the promise of access to timely and proper care and collaboration created in this NPS meeting pays off and helps policy makers see the importance of making chronic pain a high priority issue for society. More information can be found at www.painsproject.org.

About the Author:
Barby Ingle suffers from Reflex Sympathetic Dystrophy (RSD) and endometriosis. She is a chronic pain educator, patient advocate, motivational speaker, best-selling author, and president of the Power of Pain Foundation. More information about Barby can be found by clicking here.

 

Huffington Post

Online Tools Can Help Manage Pain

By Lisa Rapaport
         (Excerpt of Reuters article published on June 26, 2015)

Researchers tested a series of web-based pain management tutorials on a group of adults who had been suffering symptoms for more than six months. Regardless of how much contact the patients had with clinicians, they all experienced significant reductions in disability, anxiety and average pain levels at the end of the eight week experiment as well as three months down the line.

“While face-to-face pain management programs are important, many adults with chronic pain can benefit from programs delivered via the internet, and many of them do not need a lot of contact with a clinician in order to benefit,” lead study author Blake Dear, a psychology researcher at Macquarie University in New South Wales, said by email.

“More broadly speaking, it may be that the most critical information that patients get from doctors working with an internet-based pain management program is communicated relatively quickly, and that additional contact does not really matter,” Rini, who wasn’t involved in the study, said by email.


Read the full article at Reuters.