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Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011.

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

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6A Blueprint for Transforming Pain Prevention, Care, Education, and Research

Progress occurs when courageous, skillful leaders seize the opportunity to change things for the better.

—Harry S Truman

This report has provided an overview of the causes, impact, prevalence, and scope of pain; presented pain as a public health problem; identified barriers to high-quality and accessible pain care; delineated specific groups that may be undertreated for pain; outlined strategies for improving the training of pain researchers; and described opportunities for public–private partnerships and collaborations in pain research, care, and education. The report has also identified challenges in educating patients, the public, and providers with respect to pain and examined the current state of basic knowledge about pain and ways in which pain research is funded and organized. In reviewing the evidence in these areas, the report has identified knowledge gaps, barriers, opportunities to move the field forward, and ways to transform how pain is understood and treated.

The committee’s goal in preparing this report was to provide a broad overview of the topics included in its charge (see Chapter 1, Box 1-1) and delineate a direction and priorities for achieving change. The committee recognizes that other groups, such as the Interagency Pain Research Coordinating Committee and the Pain Consortium of the National Institutes of Health (NIH), will make use of the broad direction provided by this report and undertake their own processes to improve the understanding of pain and its treatment.

As discussed in Chapter 2, pain is experienced by virtually everyone yet is unique in its perception and experience for each person. Accordingly, broad recommendations such as those offered by the committee can yield general change, but not improvement that will be palpable to every affected individual. A standard clinical algorithm for diagnosing and treating every patient lies well beyond the scope of this report (and may not be achievable in any event). The committee did not analyze the complexities of individual pain conditions and diseases associated with pain. Nor did it analyze in depth the controversies surrounding opioid abuse and diversion. However, the committee hopes that its findings and recommendations will be transformative for the lives of many of the 116 million American adults experiencing chronic pain and those with acute pain as well.

The committee determined that transforming pain prevention, care, education, and research will require carefully planned and coordinated actions by numerous leaders and organizations. Many actors should contribute to the formation of a new national pain strategy. For example, the NIH Pain Consortium should be strengthened and its activities expanded. A comprehensive strategy will ensure that actions to address the problem of pain will be both efficient and effective.

The recommendations in this report are designed to assist policy makers; federal agencies within and outside the Department of Health and Human Services; state and local health departments; primary care practitioners; pain specialists; other health professionals; health care provider organizations; health professions associations; private insurers; researchers; funders; educators; pain advocacy and awareness organizations; the public; and, most important, people living with pain and their families, friends, and colleagues. The ultimate goal is to improve outcomes of care and return people to their maximum level of functioning. The basis for the committee’s recommendations consists of scientific evidence, direct testimony, and the expert judgment of the committee’s diverse membership. Principles underlying the recommendations were presented in Chapter 1 (Box 1-2). They include

  • pain management as a moral imperative,
  • chronic pain as sometimes a disease in itself,
  • the value of comprehensive treatment,
  • the need for interdisciplinary approaches,
  • the importance of prevention,
  • wider use of existing knowledge,
  • recognition of the conundrum of opioid use,
  • collaborative roles for patients and clinicians, and
  • the value of a public health- and community-based approach.

This chapter organizes the recommendations presented in Chapters 2 through 5 into a blueprint for action by identifying them as either immediate or near-term and enduring. The immediate recommendations are those the committee believes should be initiated now and completed before the end of 2012. The near-term and enduring recommendations build on these immediate actions, should be completed before the end of 2015, and should be maintained as ongoing efforts. Table 6-1 presents the recommendations in these two categories, along with the relevant actors and the recommendations’ key elements. (Note that the numbering scheme used in Chapters 2 through 5 is preserved here.)

TABLE 6-1. Blueprint for Transforming Pain Prevention, Care, Education, and Research.


Blueprint for Transforming Pain Prevention, Care, Education, and Research.

The committee wishes to emphasize that the comprehensive population health-based strategy set forth in Recommendation 2-2 should inform actions taken in response to, or consistent with, all of the other recommendations. The strategy should be comprehensive in scope, inclusive in its development, expeditious in its implementation, and practical in its application. Most important, the strategy must be far-reaching. As evidenced in this report, pain is a major reason for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Further, pain costs the country $560–635 billion a year according to a new, conservative estimate developed as part of this study. Given the burden of pain in terms of human lives, dollars, and social consequences, actions to relieve pain should be undertaken as a national priority.


Copyright © 2011, National Academy of Sciences.
Bookshelf ID: NBK92514
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