WASHINGTON — Every year, at least 116 million adult Americans experience chronic pain, a condition that costs the nation between $560 billion and $635 billion annually, says a new report from the Institute of Medicine. Much of this pain is preventable or could be better managed, added the committee that wrote the report.
The committee called for coordinated, national efforts of public and private organizations to create a cultural transformation in how the nation understands and approaches pain management and prevention. Some of the recommended changes can be implemented by the end of 2012 while others should be in place by 2015 and maintained as ongoing efforts.
"Given the large number of people who experience pain and the enormous cost in terms of both dollars and the suffering experienced by individuals and their families, it is clear that pain is a major public health problem in America," said committee chair Philip Pizzo, dean, Carl and Elizabeth Naumann Professor of Pediatrics, and professor of microbiology and immunology, Stanford University School of Medicine, Stanford, Calif. "All too often, prevention and treatment of pain are delayed, inaccessible, or inadequate. Patients, health care providers, and our society need to overcome misperceptions and biases about pain. We have effective tools and services to tackle the many factors that influence pain and we need to apply them expeditiously through an integrated approach tailored to each patient."
A new analysis undertaken as part of the study finds that the medical costs of pain care and the economic costs related to disability days and lost wages and productivity amount to at least $560 billion to $635 billion annually. Because the range does not include costs associated with pain in children or military personnel, it is a conservative estimate.
Health care providers, insurers, and the public need to understand that although pain is universal, it is experienced uniquely by each person and care –which often requires a combination of therapies and coping techniques — must be tailored, the report says. Pain is more than a physical symptom and is not always resolved by curing the underlying condition. Persistent pain can cause changes in the nervous system and become a distinct chronic disease. Moreover, people's experience of pain can be influenced by genes, cultural attitudes toward hardships, stress, depression, ability to understand health information, and other behavioral, cultural, and emotional factors.
Successful treatment, management, and prevention of pain requires an integrated, approach that responds to all the factors that influence pain, the committee concluded. The majority of care and management should take place through primary care providers and patient self-management with specialty care services reserved for more complex cases. Health care organizations should take the lead in developing innovative approaches and materials to coach and empower patients in self-management.
Training programs for dentists, nurses, physicians, psychologists, and other health professionals should include pain education in their curricula and promote interdisciplinary learning, the report says. Many health care professionals are not adequately prepared to provide the full range of pain care or to guide patients in self-managing chronic pain. For example, a recent study found that only five of the nation's 133 medical schools have required courses on pain and just 17 offer elective courses. Licensing and certification exams should include assessment of pain-related knowledge and capabilities. Programs that train specialists or offer training in advanced pain care need to be expanded.
The report calls on Medicare, Medicaid, workers' compensation programs, and private health plans to find ways to cover interdisciplinary pain care. Individualized care requires adequate time to counsel patients and families, consultation with multiple providers, and often more than one form of therapy, but current reimbursement systems are not designed to efficiently pay for this kind of approach and health care organizations are not set up for integrated patient management.
Due to its significant toll on individuals and society, pain warrants a higher level of attention and resources within the National Institutes of Health. The report recommends that NIH designate a lead institute to move pain research forward and increase the scope and resources of its existing Pain Consortium. NIH, academic researchers, and other public organizations should collaborate with private firms to advance research and development of new and improved therapies.
The study was mandated by Congress and sponsored by the National Institutes of Health. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. For more information, visit http://national-academies.org or http://iom.edu. A committee roster follows.
Contacts:
Christine Stencel, Senior Media Relations Officer
Shaquanna Shields, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu
Pre-publication copies of Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
INSTITUTE OF MEDICINE
Board on Health Sciences Policy
Committee on Advancing Pain Research, Care, and Education
Phillip A. Pizzo, M.D. (chair)
Dean and Carl and Elizabeth Naumann Professor of Pediatrics, Microbiology, and Immunology
School of Medicine
Stanford University
Stanford, Calif.
Noreen M. Clark, Ph.D. (vice chair)
Myron E. Wegman Distinguished University Professor;
Professor of Health Behavior and Health Education and Pediatrics; and
Director
Center for Managing Chronic Disease
University of Michigan
Ann Arbor
Olivia D. Carter-Pokras, Ph.D.
Associate Professor
Department of Epidemiology and Biostatistics
School of Public Health
University of Maryland
College Park
Myra Christopher
President and CEO
Center for Practical Bioethics
Kansas City, Mo.
John T. Farrar, M.D., Ph.D., F.A.A.N.
Assistant Professor
Department of Biostatistics and Epidemiology
School of Medicine
University of Pennsylvania
Philadelphia
Kenneth A. Follett, M.D., Ph.D
Professor and Chief of Neurosurgery
University of Nebraska Medical Center
Omaha
Margaret M. Heitkemper, R.N., Ph.D.
Chair
Department of Biobehavioral Nursing and Health Systems
University of Washington
Seattle
Charles E. Inturrisi, Ph.D.
Professor of Pharmacology
Weill Cornell Medical College
New York City
Francis J. Keefe, Ph.D.
Professor of Psychology and Neuroscience
Duke University
Durham, N.C.
Robert Kerns, Ph.D.
Professor of Psychiatry
Yale University;
National Program Director for Pain Management
Veteran Health Administration; and
Director
Pain Research, Informatics, Medical Comorbidities, and Education Center
Veterans Affairs Connecticut Healthcare System
West Haven
Janice S. Lee, D.D.S., M.D.
Associate Professor
Clinical Oral and Maxillofacial Surgery
San Francisco Medical Center
University of California
San Francisco
Elizabeth Loder, M.D., M.P.H.
Chief
Division of Headache and Pain
Department of Neurology
John R. Graham Headache Center
Brigham and Women's Hospital; and
Associate Professor of Neurology
Harvard Medical School
Boston
Sean Mackey, M.D., Ph.D.
Associate Professor
Department of Neurology and Neurological Sciences, and
Chief
Division of Pain Management
Stanford University School of Medicine
Palo Alto, Calif.
Rick Marinelli, N.D., M.Ac.O.M.
Medical Director
Natural Medicine Clinic
Portland, Ore.
Richard Payne, M.D.
Esther Colliflower Director
Institute on Care at the End of Life, and
Professor of Medicine and Divinity
Divinity School
Duke University
Durham, N.C.
Melanie Thernstrom, M.F.A
Independent Consultant
Vancouver, Wash.
Dennis Turk, Ph.D.
Professor of Anesthesiology and Pain Research
School of Medicine
University of Washington
Seattle
Ursula Wesselmann, M.D., Ph.D.
Professor of Anesthesiology
University of Alabama
Birmingham
Lonnie K. Zeltzer, M.D.
Director
Pediatric Pain Program
Mattel Children's Hospital
University of California
Los Angeles
STAFF
Adrienne Stith Butler, Ph.D.
Study Director