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

IMMEDIATE: Start now and complete before the end of 2012
RecommendationActorsKey Elements of Recommendation
2-2. Create a comprehensive population health-level strategy for pain prevention, treatment, management, and researchSecretary of Health and Human Services (HHS)Involve multiple federal, state, and private-sector entities, such as the National Institutes of Health (NIH), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ), Health Resources and Services Administration (HRSA), Centers for Medicare and Medicaid Services (CMS), Department of Defense (DoD), Department of Veterans Affairs (VA), outcomes research community and other researchers, credentialing organizations, pain advocacy and awareness organizations, health professions associations (including pain specialty professional organizations), private insurers, health care providers, state health departments, Medicaid programs, and workers’ compensation programs
3-2. Develop strategies for reducing barriers to pain careHHS Secretary, AHRQ, CMS, HRSA, Surgeon General, Office of Minority Health, Indian Health Service, VA, DoD, large health care providers (e.g., accountable care organizations)Key part of the strategy envisioned in Recommendation 2-2
3-4. Support collaboration between pain specialists and primary care clinicians, including referral to pain centers when appropriateCMS, VA, DoD, health care providers, pain specialists, pain centers, primary care practitioners, pain specialty professional organizations, primary care professional associations, private insurersThe pain specialist role includes serving as a resource for primary care practitioners
5-1. Designate a lead institute at the National Institutes of Health responsible for moving pain research forward, and increase the support for and scope of the Pain ConsortiumNIHInvolve pain advocacy and awareness organizations; foster public-private partnerships
NEAR-TERM AND ENDURING: Build on immediate recommendations, complete before the end of 2015, and maintain as ongoing efforts
RecommendationActorsKey Elements of Recommendation
2-1. Improve the collection and reporting of data on painNational Center for Health Statistics (NCHS) (part of CDC), AHRQ, CMS, VA, DoD, state and local health departments, private insurers, outcomes research community, other researchers, large health care providers, designers of electronic medical recordsBased on Recommendation 2-2; foster public–private partnerships; includes subpopulations at risk for pain and undertreatment of pain, characteristics of acute and chronic pain, and health consequences of pain (morbidity, mortality, disability, related trends)
3-1. Promote and enable self-management of painHealth professions associations (including pain specialty professional organizations), pain advocacy and awareness organizations, health care providersRequires the development of better and more evidence-based patient education products
3-3. Provide educational opportunities in pain assessment and treatment in primary careCMS, VA, DoD, graduate medical education (GME) and continuing medical education (CME) primary care programs (backed by accreditation, licensure, and certification authorities and examiners), nurse practitioner and physician assistant training programs, researchers, health care providersImproved health professions education requires a stronger evidence base on clinical effectiveness and more interdisciplinary training and care
3-5. Revise reimbursement policies to foster coordinated and evidence-based pain careCMS, VA, DoD, Medicaid programs, private insurers, health care providers, health professions associations (including pain specialty professional organizations), pain advocacy and awareness organizationsRequires the development of more evidence on clinical effectiveness and collaboration between payers and providers
3-6. Provide consistent and complete pain assessmentsHealth care providers, primary care practitioners, pain specialists, other health professions, pain clinics and programs, World Health Organization (WHO)WHO should add pain to the International Classification of Diseases, Tenth Edition (ICD-10)
4-1. Expand and redesign education programs to transform the understanding of painFDA, CDC, AHRQ, CMS, Surgeon General, DoD, VA, pain advocacy and awareness organizations, health professions associations (including pain specialty professional organizations), private insurers, health care providersFocus is on patient education and public education; includes pain prevention
4-2. Improve curriculum and education for health care professionalsCMS, HRSA Bureau of Health Professions, accrediting organizations,a undergraduate and graduate health professions training programs (backed by licensure and certification authorities and examiners)CMS’s role is that of payer for GME; include interdisciplinary training
4-3. Increase the number of health professionals with advanced expertise in pain carePain medicine fellowship programs and graduate education programs in dentistry, nursing, psychology and other mental health fields, rehabilitation therapies, pharmacy, and other health professionsRequires more effort to attract young health professionals to pain programs; also requires collaboration between educators and clinicians
5-2. Improve the process for developing new agents for pain controlFDA, NIH, pharmaceutical manufacturing and research industry, academically based biomedical research community, private funders of pain researchBased on Recommendation 5-1; involves developing new and faster ways to evaluate and approve new pain therapies, e.g., novel forms of patient stratification in clinical trials and novel investigative endpoints
5-3. Increase support for interdisciplinary research in painNIH, AHRQ, CDC, DoD, VA, pharmaceutical manufacturing and research industry, private funders of pain research, academically based biomedical research community, pain advocacy and awareness organizationsBased on Recommendation 5-1; basic, translational, and clinical studies should involve multiple agencies and disciplines; focus on knowledge gaps
5-4. Increase the conduct of longitudinal research in painNIH, AHRQ, CDC, DoD, VA, pharmaceutical manufacturing and research industry, Patient-Centered Outcomes Research Institute, private funders of pain research, academically based biomedical research community, outcomes research community, pain advocacy and awareness organizationsBased on Recommendation 5-1; includes translational, population health, and behavioral aspects of pain care (social and multimodal aspects, not just medications and other single modalities); focus is on real-world situations (comparative effectiveness, not just efficacy); foster public–private partnerships
5-5. Increase the training of pain researchersNIH, NCHS, AHRQ, CMS, academic medical institutionsIncludes more interdisciplinary training
a

Accrediting organizations include the Liaison Committee on Medical Education, Commission on Osteopathic College Accreditation, Accreditation Council for Graduate Medical Education, Commission on Dental Accreditation, Commission on Collegiate Nursing Education, National League for Nursing Accreditation Commission, American Psychological Association Committee on Accreditation, Council on Education for Public Health, Council on Social Work Education, and Council for Higher Education Accreditation (Perez et al., 2007).

Accrediting organizations include the Liaison Committee on Medical Education, Commission on Osteopathic College Accreditation, Accreditation Council for Graduate Medical Education, Commission on Dental Accreditation, Commission on Collegiate Nursing Education, National League for Nursing Accreditation Commission, American Psychological Association Committee on Accreditation, Council on Education for Public Health, Council on Social Work Education, and Council for Higher Education Accreditation (Perez et al., 2007).

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

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

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