The Institute of Medicine’s Committee on Advancing Pain Research, Care, and Education released its report “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research” today.
The committee, shares with us that at least 116 million US adults are burdened by chronic pain resulting in an estimated annual national economic cost of $560-635 billion. A brief report is available at http://ht.ly/5t7MT.
The committee, chaired by the Dean of Stanford University School of Medicine, Professor Philip Pizzo, MD comes to one basic conclusion.
“Pain affects the lives of more than a hundred million Americans, making its control of enormous value to individuals and society. To reduce the impact of pain and the resultant suffering will require a transformation in how pain is perceived and judged both by people with pain and by the health care providers who help care for them. The overarching goal of this transformation should be gaining a better understanding of pain of all types and improving efforts to prevent, assess, and treat pain.”
They used several important underlying principle to inform their charge: To provide a blueprint for transforming the way pain is understood, assessed, treated and prevented.
- A moral imperative
- Chronic pain can be a disease in itself
- Value of comprehensive treatment
- Need for interdisciplinary approaches
- Importance of prevention
- Wider use of existing knowledge.
- The conundrum of opioids
- Roles for patients and clinicians
- Value of a public health and community-based approach.
To highlight “The conundrum of opioids” as an underlying principle the following detail is provided:
The committee recognizes the serious problem of diversion and abuse of opioid drugs, as well as questions about their usefulness long-term, but believes that when opioids are used as prescribed and appropriately monitored, they can be safe and effective, especially for acute, post-operative, and procedural pain, as well as for patients near the end of life who desire more pain relief.
We have discussed a number of recent reports that highlight barriers including the JAMA report by Volkow and McLellan (JAMA 305; 13) and the committee confirms that significant barriers to adequate pain care exist (Finding 3.2) and in particular
Regulatory, legal, educational and cultural barriers inhibit the medically appropriate use of opioid analgesics.
And they go on to make Recommendation 3.2. “Develop strategies for reducing barriers to pain care.”
The population-level strategy referred to in Recommendation 2-2 should include identifying and developing comprehensive approaches to overcoming existing barriers to pain care, especially for populations that are disproportionately affected by and undertreated for pain. Strategies also should focus on ways to improve pain care for these groups.
So a public health approach for the management of pain is recommended, one that is not only addressing the educational and research challenges for the future but one that addresses the ongoing care of those with pain. Opioids are part of this ongoing care and will need to be addressed in a balanced manner, an approach that has long been supported by the PPSG.
It is another reason to ensure that the issue of opioid access is addressed at the UN meeting on Non-Communicable Diseases. It is a problem not just for the USA but for the world.