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Appendix A
Data Sources and Methods
The Committee on Advancing Pain Research, Care, and Education was asked
to assess the current state of the science with respect to pain research, care, and
education and explore approaches to advancing the field. The purpose of this
study was to review the public heath significance of pain; identify barriers to
appropriate pain care and strategies for reducing those barriers; identify popula -
tions undertreated for pain; identify tools and strategies for enhancing training
of pain researchers; and examine opportunities for public–private partnerships
to support pain research, care, and education. To respond comprehensively to its
charge, the committee examined data from a variety of sources. These sources
included a review of the recent literature, public input obtained through a series
of meetings, a commissioned paper, and written public comments on aspects of
the study charge. The study was conducted over a 10-month period.
DESCRIPTION OF THE STUDY COMMITTEE
The study committee comprised 19 individuals with expertise in pain re-
search, pain management, pharmacology, the behavioral sciences, clinical
specialties (pediatrics, oncology, infectious disease, neurology, neurosurgery,
anesthesiology, pain medicine, dentistry, and complementary medicine), chronic
disease, clinical teaching, epidemiology, ethics, and consumer education, as well
as those who have suffered personally from chronic pain and could reflect the
perspectives of the many people affected by pain. See Appendix D for biographi-
cal sketches of the committee members. The committee convened for five 2-day
meetings in November 2010, January 2011, February 2011, March 2011, and
April 2011.
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LITERATURE REVIEW
Several strategies were used to identify literature relevant to the com mittee’s
charge. First, a search of bibliographic databases, including MEDLINE and
PsycINFO, was conducted to obtain articles from peer-reviewed journals. In
addition, WorldCat and the New York Academy of Medicine’s Grey Literature
database was searched for books, reports, and other types of grey literature. The
searches focused on pain epidemiology, assessment, treatment, education, and
training. The keywords used included pain and diagnosis, treatment, manage-
ment, analgesics, drug prescriptions, complementary therapies, practice pat-
terns, public health, epidemiology, chronic disease, acute pain, communication
barriers, physician-patient relations, caregivers, health services accessibility,
health knowledge and attitudes, health care delivery, education (medical, con -
tinuing, graduate, internship and residency, nursing, pharmacy, psychology,
public health professional, nonprofessional, non-medical, professional develop -
ment, professional standards), curriculum, ethnic groups, population groups,
aged, child, cognition disorders, women, sex factors, comorbidity, disparities,
racial and ethnic differences, stereotyping, psychology, research (behavioral, bio-
medical, genetic, translational, interdisciplinary, qualitative, empirical), food and
drug administration, department of veterans affairs, military medicine, depart-
ment of defense, and public-private sector partnerships. Staff sorted through ap-
proximately 3,500 articles to identify those that were relevant to the com mittee’s
charge and created an EndNote database. In addition, committee members, meet-
ing participants, and the public submitted articles and reports on these topics.
The committee’s database included more than 2,600 relevant articles and reports.
PUBLIC MEETINGS
The committee hosted four public meetings to obtain additional information
on specific aspects of the study charge. These meetings were held in conjunc-
tion with the committee’s November, January, February, and March meetings.
The committee determined the topics and speakers for the public meetings. The
committee also held open forums at each public meeting at which members of
the public were encouraged to provide testimony on any topics related to the
study charge.
The first meeting was intended to focus on a discussion of the commit -
tee’s task. Representatives from the study’s sponsors reviewed and discussed the
charge to the committee. The second meeting focused on data collection on pain
and opportunities for public–private partnerships. The third meeting featured
speakers who discussed cultural and anthropological views on pain and financing
of pain care. The final meeting addressed the basic science of pain and its transla -
tion to clinical practice, as well as the regulation of pain drugs. At each meeting,
the committee heard testimony and comments from a broad range of stakeholders,
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APPENDIX A
including individuals living with pain, family members of people living with
pain, health care providers, representatives of the pharmaceutical industry, and
individuals representing pain advocacy groups. The committee found this input
to be highly informative for its deliberations. Agendas for the four meetings are
presented in Boxes A-1 through A-4.
In addition to testimony at these meetings, the committee solicited public
input on topics relevant to its charge through its website. More than 2,000 indi-
viduals provided written testimony. A summary of these comments can be found
in Appendix B.
COMMISSIONED PAPER
The committee commissioned a paper on the economic burden of pain. The
specific aim of this work was to provide an assessment of the economic and
societal costs of pain and pain care, including such topics as health care expendi -
tures, out-of-pocket costs, costs related to lost work or unemployment, and other
individual-level impacts (see Appendix C).
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284 RELIEVING PAIN IN AMERICA
BOX A-1
Committee on Advancing Pain
Research, Care, and Education
The National Academies Keck Building
500 Fifth Street N.W.
Washington, D.C.
AGENDA FOR PUBLIC SESSIONS
Monday, November 22, 2010
Room 201
1:00 p.m. WELCOME AND INTRODUCTIONS
Philip A. Pizzo, M.D.
Chair
1:15 p.m. DELIVERY OF STUDY CHARGE
Lawrence A. Tabak, D.D.S., Ph.D.
NIH Principal Deputy Director
1:30 p.m. DISCUSSION OF STUDY CHARGE WITH SPONSOR
2:30 p.m. ADJOURN OPEN SESSION
Tuesday, November 23, 2010
Room 100
9:00 a.m. WELCOME AND COMMITTEE INTRODUCTIONS
Philip A. Pizzo, M.D.
9:15 a.m. STAKEHOLDER PERSPECTIVES
Tina M. Tockarshewsky
President and CEO
The Neuropathy Association
Terrie Cowley
President
The TMJ Association, Ltd.
Peter Reinecke
Principal
Reinecke Strategic Solutions, Inc.
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285
APPENDIX A
Gwenn Herman, LCSW-C, DCSW
Executive Director
Pain Connection
Chronic Pain Outreach Center, Inc.
Malcolm Herman, Esq.
The American Pain Foundation
Romy Gelb-Zimmer, MPP
Associate Director
Federal Regulatory and Payment Policy
American Academy of Nurse Anesthetists
Robert J. Saner
Principal
Powers, Pyles, Sutter & Verville PC
11:30 a.m. ADJOURN
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286 RELIEVING PAIN IN AMERICA
BOX A-2
Committee on Advancing Pain
Research, Care, and Education
The National Academies Keck Building
500 Fifth Street N.W.
Washington, D.C.
AGENDA FOR PUBLIC SESSION
Tuesday, January 4, 2011
Room 101
10:00 a.m. WELCOME AND INTRODUCTIONS
Philip A. Pizzo, M.D., Chair
10:10 a.m. PUBLIC COMMENTS
Michael Ashburn, M.D., M.P.H.
American Pain Society (APS) and
American Society of Anesthesiologists (ASA)
11:00 a.m. DATA COLLECTION ON PAIN AT THE FEDERAL LEVEL
C
enters for Disease Control and Prevention, National Center for
Health Statistics
J ennifer Madans, Ph.D.
Co-Deputy Director
Associate Director for Science
Veterans Health Administration
Lynette Nilan, R.N., Ed.D.
Director, Strategic Planning and Measurement
Patient Care Services
Michael E. Clark, Ph.D.
Clinical Director, Pain Rehabilitation Program
James A. Haley Veterans Hospital, Tampa
Department of Defense
CDR Necia Williams, M.C., United States Navy
Chief, Integrated Anesthesia Services
Walter Reed Army Medical Center
National Naval Medical Center
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287
APPENDIX A
LTC Scott R. Griffith, M.D., United States Army
Consultant, Pain Management
Walter Reed Army Medical Center
12:30 p.m. BREAK FOR LUNCH
Committee will meet in closed session for lunch. Members of the public
may obtain lunch in the cafeteria located in the third floor Atrium.
1:15 p.m. PUBLIC–PRIVATE PATNERSHIPS
Robert Dworkin, Ph.D.
University of Rochester Medical Center
Director, Analgesic Clinical Trial Innovations, Opportunities, and
Networks (ACTION), a public-private partnership with the FDA
Story C. Landis, Ph.D.
Director, National Institute of Neurological Disorders and Stroke
2:15 p.m. PUBLIC COMMENTS
Andrew Bertagnolli
American Chronic Pain Association
Penney Cowan
Founder, Executive Director
American Chronic Pain Association
David St. Peter, M.D., F.H.M.
Society of Hospital Medicine and Pacira Pharmaceuticals, Inc.
Carol Drury
Associate Director
Endometriosis Association
Chip Amoe
Assistant Director, Federal Affairs
American Society of Anesthesiologists
2:45 p.m. ADJOURN OPEN SESSION
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BOX A-3
Committee on Advancing Pain
Research, Care, and Education
Hotel Monteleone
214 Royal Street
New Orleans, LA 701302201
AGENDA FOR PUBLIC SESSIONS
Tuesday, February 8, 2011
10:00 a.m. WELCOME AND INTRODUCTIONS
Philip A. Pizzo, M.D., Chair
10:10 a.m. CULTURAL VIEWS OF PAIN
David B. Morris, Ph.D.
Emeritus Professor of English
University of Virginia
Mary-Jo DelVecchio Good, Ph.D.
Professor of Social Medicine
Harvard Medical School
Linda Garro, Ph.D.
Professor
Department of Anthropology
University of California, Los Angeles
12:00 p.m. COMMITTEE WILL MEET IN CLOSED SESSION FOR LUNCH
1:00 p.m. FINANCING AND RESOURCES FOR PAIN CARE
Jeffrey Livovich, M.D.
Medical Director, Aetna Inc.
National Medical Policy and Operations
2:00 p.m. PUBLIC COMMENTS
Todd Sitzman, M.D.
Medical Director
Advanced Pain Therapy, LLC
Barbara St. Marie, MA, RN-BC, CS, ANP, GNP
Nurse Practitioner Healthcare Foundation
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289
APPENDIX A
Harry Gould, M.D.
Professor
Department of Neurology
LSU Health Sciences Center
Dennis Paul, M.D.
Associate Professor
Department of Pharmacology
LSU Health Sciences Center
Art Morelli, M.D.
Vice President, Medical Affairs
Clovidien Pharmaceuticals
Philip A. Saigh, Jr.
Executive Director
American Academy of Pain Medicine
Angie Gravois
Patient and Nurse, Picayune, Mississippi
Janet Chambers
President
Association for Fibromyalgia and Chronic Pain
Jon Russell, M.D., Ph.D.
Associate Professor
Department of Medicine
University of Texas Health Science Center at San Antonio
3:00 p.m. ADJOURN OPEN SESSION
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BOX A-4
Committee on Advancing Pain
Research, Care, and Education
The National Academies Beckman Center
100 Academy
Irvine, CA 92617
AGENDA FOR PUBLIC SESSIONS
Monday, March 14, 2011
1:00 p.m. WELCOME AND INTRODUCTIONS
Philip A. Pizzo, M.D., Chair
1:05 p.m. BASIC SCIENCE OF PAIN AND APPROACHES TO PAIN TREATMENT
Clifford J. Woolf, M.D., Ph.D.
Professor of Neurobiology
Harvard Medical School
Howard L. Fields, M.D., Ph.D.
Professor, Neurology and Physiology
University of California, San Francisco
Frank Porreca, Ph.D.
Professor of Pharmacology and Anesthesiology
University of Arizona
2:20 p.m. Discussion
3:00 p.m. Break
3:15 p.m. REGULATION OF PAIN DRUGS: PERSPECTIVES FROM THE FDA
Bob A. Rappaport, M.D. (by phone)
Director
Division of Anesthesia and Analgesia Products
Center for Drug Evaluation and Research, FDA
4:00 p.m. PUBLIC COMMENTS
Heather Grace
American Pain Foundation/Intractable Pain Patients United
Lakewood, CA
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291
APPENDIX A
Douglas Cook
American Pain Foundation/Intractable Pain Patients United
Lancaster, CA
Radene Marie Cook
American Pain Foundation
Lancaster, CA
5:00 p.m. ADJOURN OPEN SESSION
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