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A University of Nebraska Medical Center neurosurgeon, Ken Follett, M.D., Ph.D., was part of an Institute of Medicine committee that developed a report on chronic pain, a condition that annually impacts at least 116 million adult Americans and costs the nation between $560 billion and $635 billion.
The report found that much of this pain is preventable or could be better managed. 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.
Dr. Follett, who is professor and chief of neurosurgery at UNMC, was one of 19 members on the committee that developed the report. He was the only neurosurgeon on the committee.
The report was mandated by Congress as part of health care reform legislation. Sponsored by the National Institutes of Health (NIH), it was conducted over a nine-month period.
"Chronic pain is a huge problem," Dr. Follett said. "It affects more people than heart disease, cancer and diabetes combined and costs more to manage than any of these diseases. It has truly become a public health issue for our country."
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, Dr. Follett said.
Pain is more than a physical symptom and is not always resolved by curing the underlying condition, he said. Persistent pain can cause changes in the nervous system and become a distinct chronic disease. 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 require an integrated approach that responds to all the factors that influence pain, Dr. Follett said.
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, Dr. Follett said.
The report’s recommendations include:
· Pain education needs to be expanded in training programs for dentists, nurses, physicians, psychologists, and other health professionals and interdisciplinary learning should be promoted.
· 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.
· Primary care providers should be supported in their pain care efforts through improved education about pain and its treatment, opportunities for collaboration with pain specialists, and reimbursement that is commensurate with their role as primary providers of pain care.
· Medicare, Medicaid, workers’ compensation programs, and other public and private health plans must find ways to cover interdisciplinary pain care, as 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.
· The NIH needs to designate a lead institute to move pain research forward.
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. 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. Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.
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UNMC physician is part of national committee that develops report on chronic pain
