A cultural transformation is needed in the U.S. in terms of how people understand and approach the treatment of chronic pain, according to a new government report.
A committee from the Institute of Medicine wrote that many cases of chronic pain are preventable, or could be better managed. At least 116 million adult Americans experience chronic pain, a condition that costs the nation between $560 billion and $635 billion annually, the report said.
Coordinated, national efforts of public and private organizations are needed to bring about the needed cultural shift, the committee wrote.
"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, a professor of microbiology and immunology at Stanford University School of Medicine.
The problem with the way U.S. culture now deals with pain is that "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," Pizzo said.
A widespread — but uniquely personal — problem
Although pain is universal, it is experienced uniquely by each person, the report said. Health care providers, insurers and the public need to understand that uniqueness, and medical care for those experiencing pain must be tailored, the report said.
People's experience of pain can be influenced by their genes, cultural attitudes toward hardship, stress, depression and other behavioral, cultural and emotional factors, the report said.
Pain is more than a physical symptom, and is not always alleviated by curing the underlying condition. Persistent pain can cause changes in the nervous system, leading to a distinct chronic disease.
Successful treatment, management and prevention of pain requires an integrated approach that responds to all the factors that influence pain, the committee concluded.
What needs to change
Primary care providers should perform the majority of care and management of patients with chronic pain, the report said. Specialty care services should be reserved for more complex cases.
Currently, many health care professionals are not fully prepared to provide pain care, or to guide patients in managing their own chronic pain, the report said. For example, a recent study found that only five of the nation's 133 medical schools require courses on pain, and just 17 offer elective courses.
Pain education needs to be included in the curricula for health care professionals, the committee said. Exams should measure pain-related knowledge and capabilities, and programs that train specialists in pain care should be expanded.
Health care organizations should develop innovative approaches and materials to coach patients in self-management.
Medicare, Medicaid, private health insurers should to find ways to cover interdisciplinary pain care, the report said. This means giving physicians enough time to counsel patients and families, and to consult with other providers. Current reimbursement systems are not designed to efficiently pay for this kind of approach.
The National Institutes of Health should give a more attention and resources to pain care, the report said.
Some of the recommended changes could be implemented by the end of 2012, while others should be in place by 2015 and maintained as ongoing efforts, the committee said.
Prepublication copies of the report, titled "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research," are available on the National Academies of Sciences website.
Pass it on: Chronic pain needs more understanding and better treatment in the U.S.