Thursday, April 9, 2015

Do Your Little Bit of Good: National Pain Strategy Comment Period Ends May 20

Do Your Little Bit of Good:
National Pain Strategy Comment Period Ends May 20

2.2 Create a comprehensive population health-level strategy for pain….
(Complete before the end of 2012)

In June 2011, those of us who served on the Institute of Medicine’s committee that published Relieving Pain in America sent our report to Congress. It included sixteen recommendations to improve care for at least 100 million Americans who live with chronic pain. It provided what we referred to as a blueprint to “transform the way pain is perceived, judged and treated.”

Our first recommendation (2.1) was to “improve the collection and reporting of data on pain.” We had all been dismayed to learn how little reliable data we actually had to draw from in our process. The second recommendation (2.2) was to “create a comprehensive population health-level strategy for pain prevention, treatment, management, and research. Our “blueprint” was fundamentally a timeline which sequenced our recommendations. We ranked the population health-strategy as our first priority and asked that it be completed within 18 months, i.e., by the end of 2012.

It has been my privilege to serve on the National Pain Strategy Oversight Committee, which was charged by the Department of Health and Human Services (HHS) with developing the plan called for by the IOM. Unfortunately, that charge was not issued until the end of 2012 and the process took much longer than we had anticipated. The committee’s work was completed last summer and then it entered the vetting process. The good news, however, is that last week the National Pain Strategy Report was posted in the Federal Register. Until May 20, 2015, recommendations and comments from the public are possible.

We wish to strongly encourage all of those interested in efforts to improve chronic pain care to review this document and share your thoughts about it. You can do so by going to -

The report is only 43 pages and is organized in six sections: 1) Population Research, 
2) Prevention and Care, 3) Disparities, 4) Service Delivery and Reimbursement, 5) Professional Education and Training, 6) Public Education and Communication.

Each section contains a statement of “the problem” and then provides objectives and strategies for remedying that problem. From my perspective, some of the Report’s most important objectives are to:
• Foster the collection of more and better data for all populations, including developing metrics for measuring progress. (Good solutions always start with good facts.)
• Determine and analyze the benefit and cost of current prevention and treatment approaches and create incentives for using those treatments with high benefit-to-cost ratios. (Get the biggest bang for the buck.)
• Develop standardized and comprehensive pain assessments and outcome measures intended to increase functionality. (Move beyond 1-10 pain scales.)
• Acknowledge and address biases in pain care. (Biases that are implicit, conscious or unconscious.)
• Demonstrate the benefit of inter-disciplinary, multi-modal care, including behavioral health, for chronic pain. (Pain is a complex issue that requires complex solutions.)
• Align reimbursement with care models that produce optimal patient outcomes. (Both public and private payers are critical to reform.)

Perhaps, most important of all, however, is to improve health literacy, communication and education about pain among patients, healthcare providers, policy makers and the public. 

More than 80 pain and policy experts from across the country volunteered their time to develop this report. Many others in federal agencies have also been involved, and all agreed to the following vision:
If the objectives of the National Pain Strategy are achieved,
the nation would see a decrease in the 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 the broad continuum —
would have timely access to  a care system that meets their
bio-psychosocial 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 a just
and productive society. 

All those involved in developing the report are committed to getting it right, and to do so, it is critical that people living with chronic pain, their families and those who care for them (especially primary care providers) provide input and feedback. To paraphrase Bishop Desmond Tutu, “Do your little bit of good…. It is those things put together that change the world.”


Blogger pain care improvement said...

People in pain are not populations and shouldnt be treated like they are a population. So the uniformitarian approach to pain and problems in pain care- will surely fail- as it fails to recognize the great heterogeneity in the world of pain. So a biopsychosocial interdisciplinary model- a one size fits all model(and an underresearched and unproven model) will also fail individuals in pain.
Its remarkable to me how so called pain experts and their professionalized lay experts make so much out of what they know and so little out of what they dont know. But, their underpowered, underresearched and misguided occupational strategy they call the NPS will not help individuals in pain much as it doesnt call for lowering the prevalence of any pain conditionor lowering pain scores or returning people to work or lowering the burden of treatment. Pain Carew ill remain An American Tragedy and the NPS has failed our NAt

Thursday, April 09, 2015  
Anonymous Anonymous said...

As a person suffering from chronic pain and pain originating from chronic illness, I find the NPS intrusive, costly, unmanageable, and misinformed.

Research remains incomplete and flawed. Even researchers don't support over-generalizations! Some results are skewed by agendas - from the DEA; pharma-supported "advocates;" researchers hungry for HHS dollars; professionals juggling for status.

The voices of people suffering have also been drowned out by concerns for illegal users.

However well-meaning, the committee behind this report was comprised of people well enough to function which absolutely skews its content. Where is the input from those whose chronic pain is life-altering to the point they're rendered housebound and in need of help for even simple tasks, whose incomes are decimated, whose mobility is impaired...

Whatever attributes of the imaginary chronic pain population targeted by this study, a substantial portion of chronic pain patient experiences have been left out. Finding doctors to diagnose accurately has been an ordeal; keeping pain management protocols worked out arduously over years are in jeopardy for no reason other than prescriber fears.

The cost-benefit approach is a huge risk for patients who benefit greatly from injections - already targeted as "less effective". Tell that to my family - those injections might not be a panacea but they meant the difference between having me participate in Xmas or not - how will the NPS measure that kind of value?!

After nearly two decades, I look back and wish my younger self knew that level of pain would be welcome compared to what life is like now. If doctors had been willing/able to attack the pain with opiate therapy earlier would my brain/CNS have avoided misinterpreting touch as a painful stimulus?

And all the monies wasted on years of physical therapy and countless multi-modal practitioners... Maybe a decent stress-relieving vacation would have been better.

My family is one of the millions on the precipice due to medical debt. The prospect of more debt, as would be required by the bio-psycho-social tactics in the NPS will surely put us over the edge - unless I jump off first. Remember how suicide rates among those in intractable pain were one reason that pain-relieving opiate medications became accessible?

I strongly urge those well-meaning individuals behind the NPS to reconsider its impact on chronic pain individuals. And to evaluate its impact on those with severe intractable pain suffering for years (not months!)

Thank you.

Friday, May 01, 2015  

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