The committee considered NIH’s specification of topics to be comprehensive, and instead of attempting to repeat the effort to identify specific topics for research, focused its deliberations on what is needed to optimize pain research initiatives. Nor did the committee address in detail overall workforce needs because NIH has stated plans for its own effort in that area later in 2011.

The U.S. research establishment is not alone in placing increasing emphasis on the need for improvements in pain knowledge. The International Association for the Study of Pain (IASP) has made October 2010 to October 2011 the “Global Year Against Acute Pain,” highlighting a number of research-related problems that are barriers to better acute pain treatment, including

  • incomplete, sporadic, or nonstandard pain assessment;
  • limited transferability of results derived from randomized controlled trials (RCTs) to clinical practice;
  • other problems in evidence transfer, including general barriers to implementing evidence-based and outcome-driven practices;
  • failure to capture short- and long-term quality outcomes that might be correlated with the adequacy of acute pain control; and
  • disproportionately low expenditures for basic, translational, and clinical research relative to the burden of acute pain (IASP, 2010).

In the United Kingdom, the British Pain Society is working toward developing chronic pain patient pathways, and its efforts are proceeding in parallel with the interests of the U.K. Department of Health’s Chronic Pain Policy Coalition and experts working with the National Institute for Health and Clinical Excellence, with the aim of hosting a Pain Summit in November 2011. Additionally, the Royal College of General Practitioners has established pain as one of four new clinical priorities for the years 2011 to 2013 (Baranowski, 2011).

The committee finds the new knowledge that may be developed under these international initiatives exciting but is aware that there also is a significant problem with respect to the appropriate use of currently available therapeutic modalities, and is concerned about the slow pace and unsystematic way in which important basic research results are adopted (or not) into medical practice. The concern is that “the current clinical research enterprise in the United States is unable to produce the high-quality, timely, and actionable evidence needed to support a learning health care system” (IOM, 2010, p. 7). Efforts are under way to address these issues by improving and diversifying research methods, expanding research targets, streamlining the organization and funding of research, encouraging collaboration among research teams and disciplines, and promoting public–private partnerships, but gains have been slow.

Because of the biopsychosocial complexity of the pain process (Chapter 1) and the variable ways in which different individuals and population groups are affected, assessed, and managed (Chapter 2), and because of the lack of specific



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