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Index
A Advocates, for patients with chronic pain, 24,
31, 34, 115, 184, 190, 224, 228, 239
Abuse. See also Medications for pain Afghanistan conflict, 81, 157–158
of opioids, 146–147 African Americans, disparities in prevalence
Acceptance, new emphasis on, 44 and care for, 67–70, 310
Access to opioid analgesics, 142–148 Agency for Healthcare Research and Quality
abuse of opioids, 146–147 (AHRQ), 6, 12–13, 56, 61, 72, 99, 101,
effectiveness of opioids as pain relievers, 143, 189, 249, 253–254, 304
144–145 Aging, conditions associated with, 79
need for education, 145–146 Alaska Natives, disparities in prevalence and
opioid use and costs of care, 147–148 care for, 72–73
patient access to opioids, 143–144 Allodynia, 35, 277
Access to pain care, 127–128 Allostatic load, 37, 277
Accreditation Council for Graduate Medical Alternative medicine. See Complementary and
Education (ACGME), 193, 200, 210 alternative medicine (CAM) services
Acetaminophen, 130 Alzheimer’s Association, 189
Activities of daily living, effects of pain on, Alzheimer’s disease, campaigns to educate
86, 139 about, 188–189
Acupuncture, 135–136, 208 Alzheimer’s Disease Education and Referral
Acute pain, 1, 32–33, 277 Center, 189
better treatment for, 100 American Academy of Family Physicians, 197
choice of a treatment approach for, 124, 126 American Academy of Neurology, 199, 249
common sources of, 29 American Academy of Orofacial Pain, 120
Addiction, 36, 277 American Academy of Orthopedic Surgeons,
Adequacy of pain control, in hospitals and 303
nursing homes, 140–141 American Academy of Pain Management, 120
Adherence to drug regimen, problems with, 131 American Academy of Pain Medicine, 120, 123
Adjusting to pain. See Pain adjustment American Association of Colleges of Nursing,
Advance directives, campaigns to educate 202
about, 188
349
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American Association of Naturopathic American Society of Regional Anesthesia and
Physicians, 209 Pain Medicine, 120
American Association of Orthopaedic American Urological Association, 248
Medicine, 209 Analgesia, 31, 71, 76, 277
American Back Society, 120 Analgesic Clinical Trials, Innovations,
American Board of Anesthesiology, 121, 198 Opportunities, and Networks
American Board of Medical Specialties (ACTION) initiative, 231–232, 246
(ABMS), 198–199, 210 Anesthetic interventions, for treating people
American Board of Pain Medicine (ABPM), with pain, regional, 131
198 Anger, 4, 42
American Cancer Society (ACS), 57, 143, Annex 5-1. See “Mechanisms, Models,
188, 239 Measurement, and Management in
American Chronic Pain Association, 34, 189 Pain Research Funding Opportunity
American College of Emergency Physicians, Announcement”
203 Antianxiety medication, 78
American Dental Association (ADA), 207 Anxiety, 4, 41
American Diabetes Association, 57 Arthritis, improvements in, 118
American Geriatrics Society, 143 Asian Americans
Foundation for Health in Aging, 189 disparities in prevalence and care for,
American Headache Society, 120 71–72, 310
American Heart Association, 239 language problems for, 65
American Holistic Medical Association, Assessment
208–209 dimensions of pain, 236–237
American Indians, disparities in prevalence ongoing, and monitoring of pain and pain-
and care for, 72–73 related states, 238
American Medical Association (AMA), 120 of pain, 8, 138, 164–165, 262–263
Pain and Palliative Medicine Specialty of psychological traits and states related to
Section Council, 191 pain adjustment, 237–238
American Medical Directors Association, 143 Assistance with Pain Treatment, 122
American Neurological Association, 199 Association of American Medical Colleges, 194
American Nurses Association (ANA), 203 Australia
American Nurses Credentialing Center, 203 national cost of pain in, 92–93
American Pain Foundation (APF), 145, 189, public education campaign on low back
300 pain, 97, 185–186
American Pain Society, 120, 143, 203 Avoidance, about pain, 88
Clinical Centers of Excellence Awards
Program, 161
B
American Physical Therapy Association,
207
Back Beliefs Questionnaire (BBQ), 185–186
American Productivity Audit telephone survey,
Barriers to effective pain care, 8–9, 152–157
86
cultural attitudes of patients, 156–157
American Psychological Association (APA),
geographic barriers, 157
205–206
insurance coverage, 156
Committee on Accreditation, 210
magnitude of the problem, 9, 153
American Recovery and Reinvestment Act,
provider attitudes and training, 153–156
245
regulatory barriers, 157
American Society for Pain Management
written public testimony on, 294
Nursing, 120, 203
Barriers to improving pain care
American Society of Interventional Pain
clinician-level barriers, 45–46
Physicians, 120
overview of, 45–47
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patient-level barriers, 46–47 conclusion, 161
potential savings from improvements in, findings and recommendations, 161–165
100 issues in pain care practice, 137–152
system-level barriers, 45 models of pain care, 158–161, 227–228
Basic knowledge outcomes-based, 298
biomarkers and biosignatures, 221–222 overtreating, 299
conclusion, 223 potential savings from improvements in,
expanding, 220–223 100
opportunities in psychosocial research, 223 treatment modalities, 129–137
other promising basic research, 222–223 treatment overview, 115
Behavioral Risk Factor Surveillance System Cartesian model, of mind-body separation, 35
survey, 147 Catastrophic injuries and diseases, x, 81. See
Behavioral therapy, 132–133, 299 also Pain catastrophizing
Beliefs, 42, 71, 277 Causes of pain, 34–44
about pain, 183, 185 the brain’s role, 38–40
Best Pharmaceuticals for Children Act, 78 cognitive context, 42–44
Biofeedback, 132, 226 the complexity of chronic pain, 34–36
Biological changes, caused by pain, 31 emotional context, 40–42
Biological factors in pain, 24 genetic influences, 36–37
Biomarkers and biosignatures, 220–222 nerve pathways, 38
Biomarkers Consortium, 247 pain in childhood, 37
“Biopsychosocial model,” 35, 42, 115, 127, Center for Studying Health System Change,
227, 277 148
education in, 183, 219–220 Centers for Disease Control and Prevention
Blueprint for transforming pain prevention, (CDC), 12–13, 56, 99, 189, 253
care Centers for Medicare and Medicaid Services
education, and research, 14–17, 269–275 (CMS), 11–13, 82–83, 210, 249, 254
immediate goals, 272–273 Minimum Data Set, 83
near-term and enduring goals, 273–275 Centers of Excellence in Primary Care
Brain, role in the causes and persistence of Education, 203
pain, 38–40 Central sensitization, 33
Brennan, F., et al., 34 Cerebrovascular disease, 82
Brief Pain Inventory, 237 Certifying physicians, 198, 210
Brigham and Women’s Pain Management Challenges. See Education challenges;
Center, 161 Research challenges
British Pain Society, 219 Children
Bureau of Health Professions, 210 causes and persistence of pain in, 37
Bureau of Labor Statistics, 80 disparities in prevalence and care for,
77–78, 192
Chiropractic spinal manipulation, 135, 208
C Choice of a treatment approach, 124–127
environmental factors affecting, 125
Canada, public education campaign on low individual-related factors affecting, 125
back pain, 186 pain-related factors affecting, 125
Cancer patients, 314 Chronic fatigue syndrome, 75
disparities in prevalence and care for, 84 Chronic pain, 1, 32–33, 278, 295
fear in, 43 choice of a treatment approach for,
Cardiovascular patients, 131 126–127
Care of people with pain, 113–177. See also common sources of, 29
Barriers to improving pain care complexity of, 34–36, 300
barriers to effective pain care, 153–157 as a disease in itself, 4, 26
blueprint for transforming, 14–17, 269–275
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352 INDEX
growing public understanding of, 63 Comprehensive Severity Index (CSI), 235
inversely related to socioeconomic status, Comptroller General of the United States,
74–75 248
life-cycle factors associated with the Concerns about opioid analgesic use, 142–148
development of, 30 abuse of opioids, 146–147
reductions in complications associated effectiveness of opioids as pain relievers,
with, 100 144–145
Chronic Pain Policy Coalition, 219 need for education, 145–146
City of Hope National Medical Center, 204 opioid use and costs of care, 147–148
Clinical Centers of Excellence Awards patient access to opioids, 143–144
Program, 161 Consumer Price Index (CPI), Medical Care
Clinical pharmacy specialist, 129 inflation index of, 302
Clinical Trials Transformation Initiative, 231 Control variables, in the economic costs of
Clinician-level barriers, to improved pain care, pain, 306–307
45–46 Cost models for selected pain conditions
Clinicians, roles for, 3, 22 incremental, 316–317
CME credit, 193, 195–196 indirect, 323–324
Cognitive-behavioral therapy, 43, 132, 207, Costs of pain and its treatment, 91–95. See
226, 278 also Direct costs; Economic costs
Cognitive context, of the causes and of pain; Emotional cost of pain;
persistence of pain, 42–44 Incremental costs; Indirect costs
Cognitive impairments, disparities in to families, 94–95
prevalence and care for people with, to the nation, 56, 91–93
82–83 opioid use and, 147–148
Collaboration, need to support, 9, 163–164 and savings from a public health approach,
Collins, Francis S., 240 100
Commission on Accreditation of Rehabilitation Counseling, 4
Facilities, 123 Cowan, Penny, 34
Commissioned paper, 283, 301–337 Cowley, Terrie, 184, 217, 224
Committee on Accreditation (of the APA), 210 COX inhibitors, 225
Committee on Advancing Pain Research, Care, Credentialing physicians, 198
and Education, 301 Croft, P., et al., 95
Agendas for Public Sessions, 284–291 Cross-fertilization of ideas, 45, 121
charge to, 2 Cross-sectional analysis, 314
description of, x, 281, 339–348 Cultural attitudes of patients, a barrier to
Committee on Dental Accreditation (CODA), effective pain care, 156–157
206 Cultural transformation, 47–49
Common Fund (of the NIH), 241 and barriers to improved pain care, 45–47
Community-based approach, value of, 3 need for, 44–49, 209, 250–251
Comparative effectiveness research (CER), in the way pain is viewed and treated, 3–4
228, 232–234 Current partnership activities, 245–248
Competency-based education, 197
Complementary and alternative medicine
D
(CAM) services
education in, 208–209
Daily living. See Activities of daily living
reduced costs associated with, 93
Data on the economic costs of pain, 304–307
for treating people with pain, 93, 134–136
control variables, 306–307
Complexity of pain, 8, 24–26. See also
dependent variables, 305–306
Unknown causes of pain
key independent, 305
Comprehensive Pain Center of Sarasota,
sample, 304–305
Florida, 161
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Drug Enforcement Administration (DEA),
Data sources and methods, 281–291. See also
97, 297
Economic Costs of Pain in the United
Drugs for pain. See Medications for pain
States, The
Duke University, 231
commissioned paper, 283, 301–337
Dysmenorrhea, 33
description of the study committee, 281
and limitations, 59–61
literature review, 282
E
need to improve, 6, 101–102, 123–124
public meetings, 282–291
Economic costs of pain
shortcomings of, 60
control variables, 306–307
Databases, 234–236
data on, 304–307
Grey Literature, 282
dependent variables, 305–306
Workers’ Compensation, 304
key independent, 305
Deficits, in problem-solving ability, 88
sample, 304–305
Dementia, 83
written public testimony on, 296
Dentistry, education in, 204, 206–207
Economic Costs of Pain in the United States,
Department of Defense, 13, 56, 81, 114, 246,
The, 301–337
253
background, 302
model of pain care, 160
conclusion, 303
Department of Health and Human Services
data, 302, 304–307
(HHS), 2, 7, 20, 56, 102
discussion, 313–314
Department of Veterans Affairs, 5, 13,
estimation strategy, 307–309
56, 80–82, 93, 114, 122, 206, 246,
Education
253
competency-based, 197
Centers of Excellence in Primary Care
Internet-based, 197
Education, 203
potential savings from improvements in,
model of pain care, 158–160
100
Pain Research Program, 242
Education challenges, 10, 179–216
Dependent variables, for the economic costs of
about opioid analgesic use, need for,
pain, 305–306
145–146
Depression, xi, 4, 41, 70, 88, 118
blueprint for transforming, 10–11, 14–17,
Descartes, René, 34
269–275
Diagnosing pain. See Pain diagnoses
in complementary and alternative medicine
Direct costs
(CAM), 208–209
for medical care for pain diagnoses,
conclusion, 209
312–313
in dentistry, 206–207
for selected pain conditions, 337
findings and recommendations, 209–210
Disability. See Functional disability; Pain-
for the health professions, 56, 163,
related disability; Work disability
204–209
Discussion, on the economic costs of pain,
nurse education, 201–204
313–314
patient education, 180–184
Disease. See also Catastrophic injuries and
for patients, 180–184
diseases
in pharmacy, 208
chronic pain as, 3, 22, 26
in physical and occupational therapy,
chronic pain developing into, ix
207–208
validation accorded by, x
physician education, 190–201
Disparities in prevalence and care. See also
of primary care physicians, 196–198
Health disparities
in psychology, 204–206
by age group, 77–80
public education, 184–190
of pain in children, 77–78
tools useful in reaching the public,
of pain in the elderly, 78–80
187–188
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F
Educational background, disparities in
prevalence and care by, 73–75
Families
Effectiveness, of opioids as pain relievers,
costs of pain and its treatment to, 94–95
144–145
viewed as entities, 94
Effects of pain
Fatalism, “deeply-rooted value and belief in,”
on activities of daily living, 86
71
on productivity, 86–87
Fatigue, xi. See also Chronic fatigue syndrome
on quality of life, 87–88
Federal agencies. See also individual agencies
on the risk of suicide, 88–89
and departments
Elderly, disparities in prevalence and care for,
role of, 56
78–80
Federal research funding, obtaining, 244–245
Electronic health record systems, 101
Federation of State Medical Boards, Medical
Electronic prescription monitoring system,
and Osteopathic Practice Act (model),
calls for, 298
191
Emergency Nurses Association, 203
Ferrell, Betty, 202
Emotional context, of the causes and
Fibromyalgia, 75, 121, 137, 153
persistence of pain, 40–42
Fifth vital sign approach, 139–141
Emotional cost of pain, 5
Findings and recommendations, 4–13, 100
Emotional support, importance of, 95
audiences for, 23, 57
End of life
in caring for people with pain, 8–10,
disparities in prevalence and care for
161–165
people at, 85
conclusions, 4, 13
pain and suffering at, 141–142, 188
education challenges, 10–11, 209–210
Endometriosis, 75, 78
public health challenges, 5–7, 100–103
Enduring goals, for transforming pain
research challenges, 11–13, 250–254
prevention, care, education, and
First National Pain Medicine Summit, 191
research, 271, 273–275
Food and Drug Administration (FDA), 12–13,
English as a second language, disparities in
56, 99, 142, 224, 230, 252
prevalence and care for patients with,
Office of Critical Path Programs, 231
65–66
Regulatory Science Initiative, 224
Environments
Foundation for Health in Aging, 189
as factors in pain, 36
Functional disability, 310–314
unhealthy, 37
Functional neuroimaging, to investigate pain,
unsafe, 96
39
Epidemiology, of pain, 264–265
Functioning, hampered by pain, xi, 139–140
Estimation strategy for the economic costs of
Future of the Public’s Health in the 21st
pain, 307–309
Century, The, 57
health care expenditure models, 307–308
indirect cost models, 308–309
Ethnicity. See Racial and ethnic factors
G
Evidence-based pain care. See Pain care
Exercise, in pain management, 133–134 Gaskin, Darrell J., 301–337
Existing knowledge, wider use of, 3, 22 Gender
Expenditure models, total, for selected pain differences in the seriousness of pain by,
conditions, 319–320 89–90
Expenditures, for selected pain conditions, disparities in prevalence and care by,
318 75–77
Experiences providing pain treatment, written Generalized linear model, hourly wages
public testimony on, 294 models for selected pain conditions,
332–333
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Genetic factors in pain, 36–37, 221–222, 260 Hospice patients, 85, 141–142
Genomic data, 233, 235 Hospitals, adequacy of pain control in,
Geographic barriers, to effective pain care, 140–141
80, 157 Hourly wage reductions
Glial cells, 222, 260 for adults with selected pain conditions,
“Global Year Against Acute Pain,” 219 327
Goals, for transforming pain prevention, care, due to selected pain conditions, 336
education, and research, 270–271, Hourly wages models, for selected pain
273–275 conditions, logistic regression and
Gooddy, William, 191 generalized linear, 332–333
Grey Literature database, 282 Hours worked. See also Missed hours models
for adults with selected pain conditions,
Guidelines for Teaching the Comprehensive
312, 326
Control of Pain and Sedation to
Dentists and Dental Students, 207 Hurricanes, 157
Hydrocodone, 130
Hyperalgesia, 35, 278
H Hypnosis, 132–133, 226
Headaches, 136
fiscal challenge of caring for, 149 I
migraines, 87
Healing, pain persisting after, 35 Ibuprofen, 130
Health. See also Pain as a public health Imaging, to investigate pain, 38–39
challenge Immediate goals, for transforming pain
impact of pain on physical and mental, prevention, care, education, and
31–32 research, 270, 272–273
influence of occupational rank on, 74 Impact of pain, written public testimony on,
Health and Retirement Study, 68, 72 295
Health care expenditure models, estimation Improving pain care, written public testimony
strategy for, 307–308 on, 294
Health disparities, 265–266 Income, disparities in prevalence and care by,
Health literacy, 66 73–75
low rates of, 66 Incremental cost models, for selected pain
Health Psychology Network, 205 conditions, dependent and independent
Health Resources and Services Administration, variables used in, 316–317
11, 210 Incremental costs
Healthcare Effectiveness Data and Information of health care, 308–311
Set (HEDIS), 149–150 of medical expenditures, by source of
Healthy People 2020, 57–58 payment, 322
Pain Relief Objectives, 58 of medical expenditures for selected pain
Heart surgery, complications following, 84 conditions, 321
Heckman selection models, 309 of number of days of work missed because
Helplessness, about pain, 88 of selected pain conditions, 334
Herman, Gwenn, 180 of number of hours of work missed
Hip replacement surgeries, 132 because of selected pain conditions,
Hispanics 335
disparities in prevalence and care for, Independent factors, in the economic costs of
70–71, 310 pain, 305
language problems for, 65–66 Indian Health Service (IHS), 72, 96
HMO Research Network, 234 Indirect cost models
Hopelessness, about pain, 88 estimation strategy for, 308–309
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J
for selected pain conditions, dependent and
independent variables used in, 323–324
Jane B. Pettit Pain and Palliative Care Center,
Indirect costs
161
associated with reductions in wages due to
Joint Commission on Accreditation of
selected pain conditions, 336
Healthcare Organizations, 138, 140
of health care, 311–312
Joint pain, 79, 86
Inflammation, causing pain, 33
Joint replacement statistics, among Medicare
Initiative on Methods, Measurement, and
beneficiaries, 132
Pain Assessment in Clinical Trials
Judgmentality, 46
(IMMPACT), 231, 246
Injection therapy, 131
Injuries, causing pain, 33
K
Insomnia, 88
Institute for Healthcare Improvement, 160 Keywords searched, 282
Institute of Medicine (IOM), ix–x, 2, 20, 55, Knee replacement surgeries, 132
97, 194, 232, 243, 303 Knowledge. See Basic knowledge; Existing
Committee on Care at the End of Life, knowledge; New knowledge
143 Korean conflict, 82
publications from, 23, 69, 199
Insurance coverage, a barrier to effective pain
care, 148, 156, 298–299 L
Insurance incentives, 148–150
Lasker, Mary, 244
Integrative approach, 126
Last Acts campaign, 188
Interagency Pain Research Coordinating
Liaison Committee on Medical Education, 210
Committee, 7, 103, 269
Licensing physicians, 210
Interdisciplinary approaches, xi, 278. See also
Life-cycle factors, associated with the
Collaboration
development of chronic pain, 30
need for, 3–4, 22, 42, 197–198, 227–228
Lifesaving, progress in, 63
teams using, 121–124
Limitations of clinical trials, initiatives to
International Association for the Study of Pain
address, 230–232
(IASP), 25, 47, 120, 205, 219, 239
Limitations on data, 59–61
International Covenant on Economic, Social,
Listening skills, of physicians, 193–194
and Cultural Rights, 143
Literature review, 201, 282
Internet, education based on, 197, 252
Logistic regression, hourly wages models for
Interstitial cystitis, 75, 137
selected pain conditions, 332–333
InterTribal Council of Arizona, Inc., 72
Longitudinal research, need for, 13, 60–61,
Interviews. See Structured psychiatric
253
interview methods
Low back pain
Ion channels, 222
chronic, 63–64
Iraq conflicts, 81, 157–158
fiscal challenge of caring for, 148
Issues in pain care practice, 137–152
public education campaigns on, 97,
access to opioid analgesics and concerns
185–186
about their use, 142–148
adequacy of pain control in hospitals and
nursing homes, 140–141
M
difficulties in measuring pain, 137–140
insurance incentives, 148–150
Magnitude of the problem, of effective pain
pain and suffering at the end of life,
care, 153
141–142
Management of pain. See Pain management;
the reporting of pain, 150–152
Self-management of pain
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INDEX
Massachusetts Pain Initiative, 190 MEDLINE, 282
Massage, 135 Mental health, impact of pain on, 31–32
Massage ultrasound, 134 Methodology. See also Data sources and
Mayday Fund, 185, 189, 194, 246 methods; Structured psychiatric
McGill University, Pain Genetics Lab, 36 interview methods
Measuring pain for the economic costs of pain, 91–93, 302
difficulties in, 137–140 Migraine (Oliver Sacks), 191
and objectivity, xi–xii Migraine headaches, 87
“Mechanisms, Models, Measurement, and Mind-body separation, Cartesian model of,
Management in Pain Research Funding 35, 154
Opportunity Announcement,” 240–241, Minimum Data Set, 83
259–267 Missed days models, for selected pain
biobehavioral pain, 261 conditions, 328–329
diagnosis and assessment of pain, 262–263 Missed hours models, for selected pain
epidemiology of pain, 264–265 conditions, 330–331
genetics of pain, 260 Misuse. See Medications for pain
health disparities, 265–266 Models of pain, 262. See also Hourly wages
models of pain, 262 models; Missed days models; Missed
molecular and cellular mechanisms of hours models
pain, 259–260 Models of pain care, 158–161. See also
pain management, 263–264 Cost models for selected pain
research objectives, 259 conditions; Health care expenditure
translational pain research, 266–267 models; Indirect cost models; Quality
Mechanisms of pain, molecular and cellular, improvement (QI) model
259–260 Department of Defense, 160
Medicaid, 5, 93, 98, 147 Department of Veterans Affairs, 158–160
low physician reimbursement rates in, 296 other models, 160–161
Medical and Osteopathic Practice Act (model), “Monitoring the Future,” 146
191 Moral imperative, treating pain as, 3, 22
Medical Care inflation index, of the Consumer Moral judgment, 46
Price Index (CPI), 302 Multidimensional Pain Inventory, 237
Medical Expenditure Panel Survey (MEPS), Multimodal efforts, public health support for,
61, 91, 302, 304–305, 307, 310 98–99
Medical expenditures, for selected pain Musculoskeletal pain, 81, 118, 314
conditions, average incremental costs
of, 321
N
Medical Product Safety Objectives, 57–58
Medical treatments, causing pain, 33
Nation, costs of pain and its treatment to,
Medicare, 5, 93, 98, 150, 234
91–93
Medicare beneficiaries, joint replacement
National Alliance on Mental Illness, 57
statistics among, 132
National Ambulatory Medical Care Survey,
Medications causing pain, 130–131
130
Medications for pain, 20, 114, 120, 129–131.
National Board of Medical Examiners, 193
See also Antianxiety medication
National Cancer Institute (NCI), National
abuse and misuse, 201
Cooperative Drug Discovery Group,
insurance coverage for, 84
247
“off-label” uses of, 58
National Center for Advancing Translational
prescribing for children, 77–78
Sciences, 240
Medicine. See Complementary and alternative
National Center for Complementary and
medicine
Alternative Medicine, 134–135
Meditation, 132
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National Center for Health Statistics (NCHS), Need to improve, data sources and methods, 6,
6, 13, 61, 101, 254, 304 101–102, 123–124
National Committee for Quality Assurance, Nerve pathways, and the causes and
Healthcare Effectiveness Data and persistence of pain, 38
Information Set, 149 Nervous system, malfunctioning, 225
National Cooperative Drug Discovery Group, Neuroimaging, to investigate pain, 38–40,
247 137, 223
National Data Bank for Rheumatic Diseases, Neuromatrix theory, 38, 278
234 Neuropathic pain, 33–34, 222, 278
National Fibromyalgia Association, 189 diabetic, 249
National Health and Nutrition Examination Neuropathy Association, The, 59
Survey (NHANES), 61, 63–64, 67, 70, New analgesics, difficulty of developing,
77, 129, 131 224–225
National Health Interview Survey (NHIS), 61, New England School of Acupuncture, 208
71, 86, 135, 303 New knowledge, 56
National Hospital Ambulatory Medical Care New Pathways to Discovery, 241
Survey, 130 New York Academy of Medicine, Grey
National Institute for Nursing Research, 239 Literature database, 282
National Institute of Neurological Disorders NMDA receptor pathways, drugs acting on,
and Stroke, 243, 251 300
National Institute on Aging, 189 Nociception, 36, 39, 68, 222, 278
National Institute on Alcohol Abuse and Nonsteroidal anti-inflammatory drugs, 225
Alcoholism, 240 Norway, public education campaign on low
National Institute on Drug Abuse, 240 back pain, 186
National Institutes of Health (NIH), 12, 20, 56, Nurse Practitioner Healthcare Foundation,
92, 99, 189, 218–219, 245, 253, 313 201
Common Fund, 241 Nurses, 91, 201
National Center for Complementary and education of, 201–204
Alternative Medicine, 134 Nursing homes, adequacy of pain control in,
Pain Consortium, 7, 11–12, 103, 190, 240, 69, 142
242–244, 251–252, 269–270
Roadmap for Medical Research, 237, 241
O
National Institutes of Health Reform Act, 240
National Nursing Home Survey (NNHS), 82
Obesity, and pain, 63, 226
National Pain Management Strategy, 158
Objectives
National Research Council, 303
regarding the economic costs of pain, 302
National Violent Death Reporting System
of research, 259
(NVDRS), 89
Objectivity, x, 24. See also Measuring pain;
Native Hawaiian Health Care Systems
Subjectivity
Program, 96
Observational studies, 234–236
Near-term goals, for transforming pain
Occupational rank, influence on health, 74
prevention, care, education, and
Occupational therapy. See Physical and
research, 270, 273–275
occupational therapy
Need for a cultural transformation, 44–49,
“Off-label” uses, of drugs for pain, 58
209, 250–251
Office of Critical Path Programs, 231
the necessary cultural transformation,
Opioid use, 36, 56, 278. See also Access to
47–49
opioid analgesics
overview of barriers to improved pain care,
the conundrum of, 3, 22, 144, 225
45–47
Opioids Risk Evaluation and Mitigation
in the way pain is viewed and treated, 3–4
Strategy (REMS), 142–143
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INDEX
Organization scope of the problem, 59–64
alternative, in research, 241–243 the seriousness of pain, 85–90
of the report, 49 Pain care
Orofacial pain, 207. See also barriers to effective, 153–157
Temporomandibular joint (TMJ) bias in, xi
disorders demand for, 190
Osteoarthritis, 79 evidence-based, 10, 164
Outcome Measures in Rheumatoid Arthritis issues in, 137–152
Clinical Trials (OMERACT), 231 need to individualize, 8, 100, 161–162, 236
Outcomes-based care, 298 Pain catastrophizing, 43, 88, 94, 278
Overtreating people with pain, 299 Pain centers, 9, 98, 116, 123–124, 159–160,
Oxycodone, 130, 146 220
Pain Connection-Chronic Pain Outreach
Center, Inc., 180
P Pain Consortium, 7, 11–12, 103, 190, 240,
242–244, 251–252, 269–270
Pain. See also Acute pain; Barriers to Pain diagnoses, 262–263
improving pain care; Chronic pain; total direct costs of medical care for,
Economic costs of pain; Joint pain; 312–313
Low back pain; Musculoskeletal pain; uncertainty of, 4, 46
Neuropathic pain; Orofacial pain; Pain diaries, 238
Prevalence of pain; Referred pain; Pain Genetics Lab, 36
Seriousness of pain; Translational pain Pain in childhood, causes and persistence of,
in animals, 223 37
causes and persistence of, 34–44 Pain management, xi, 263–264. See also Self-
complexity of, 8, 24–26, 220 management of pain
definitions of, 1, 24–26, 278 Pain Management Directive, 158
impact on physical and mental health, Pain management index, 68
31–32 Pain prevention, 95–98, 233
maladaptive coping strategies, 94 blueprint for transforming, 14–17, 269–275
the picture of, and risk, 27 examples of population-based initiatives,
protection from and relief of, ix 97
romanticizing, ix importance of, 3–4, 22, 45
statistics on, 28 potential savings from improvements in,
typology of, 32–34 100
universality of, 2, 19, 55–56 role of public health in, 95–98
as a warning, 24 “Pain pumps,” 131
Pain adjustment, assessment of states related Pain-related disability, 29, 117
to, 237–238 among adults with pain, extent of, 86
Pain and Palliative Medicine Specialty Section Pain Relief Ladder, 143
Council (of the AMA), 191 Pain Research, Informatics, Medical
“Pain apathy,” 193 Comorbidities, and Education Center,
Pain as a public health challenge, 55–111 242
the costs of pain and its treatment, 91–95 Pain Research Coordinating Committee, 240
data sources and limitations, 59–61 Pain Research Program, 242
disparities in prevalence and care in Pain Research Working Group, 242
selected populations, 64 Pain resource nurse (PRN) programs, 204
findings and recommendations, 100–103 Pain specialists, 8–10, 116
overall prevalence, 61–64 training and credentialing of physicians as,
potential roles for public health, 95–100 198–201
present crisis in, xii Pain Summit, 219
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Pain tolerance, lower among African Physicians
Americans, 67 with chronic pain, 190
PainCAS, 234 education of, 190–201
Palliative care, 85. See also Hospice patients listening skills of, 193–194
“Passport to Comfort,” 118 “medical story” each is telling, 193
Patient-Centered Outcomes Research Institute, promoting physicians’ understanding of
247 medication abuse and misuse, 201
Patient education, 180–184 training and credentialing of physician pain
essential topics for, 182 specialists, 198–201
Patient Education Forum, 189 training of primary care physicians,
Patient-level barriers, to improved pain care, 196–198
46–47 visits to, 19–20
Patient Protection and Affordable Care Act, who treat chronic pain, 32
20, 47, 248 Placebos, 228
Patient-Provider Agreements, 142 note on the use of for treating people with
Patient Report Medical Outcomes Reporting pain, 136–137
System (PROMIS), 237, 242 Population-based prevention initiatives
Patients. See also Access to opioid analgesics campaign to reduce back pain disability,
with chronic pain, 19, 24, 26, 32, 59, 85, 74, 97
113, 142, 158, 179, 238, 293 examples of, 97
cultural attitudes of, 156–157 need for, 6–7
phenotyping, 223 Prescription Drug Take-Back programs, 97
roles for, 3, 22 suicide prevention, 97
written public testimony on experiences Posttraumatic stress disorder (PTSD), 81
seeking treatment for pain, 294 PPP Program, 247
Patrick and Catherine Weldon Donaghue Practice-based evidence (PBE), 235
Medical Research Foundation, 246 difficulty of developing new analgesics,
Ped-IMMPACT, 231 224–225
Pediatric ED, analgesia in, 78 moving from research to, 224–228
Peripheral sensitization, 33 need for interdisciplinary approaches,
Persian Gulf war, 82 227–228
Persistence of pain, 34–44 shortfalls in applying psychosocial
the brain’s role, 38–40 approaches in practice, 226–227
and causes, 34–44 Prescriptions, 201. See also Electronic
cognitive context, 42–44 prescription monitoring system
the complexity of chronic pain, 34–36 getting filled, 157
emotional context, 40–42 of opioids, written public testimony on
genetic influences, 36–37 difficulties surrounding, 297–298
nerve pathways, 38 President’s Commission on Care for America’s
pain in childhood, 37 Returning Wounded Warriors, 81
Pharmacist, 129 Prevalence of pain, 9, 61–64
Pharmacokinetic data, 233 key shortcomings of data on, 60
Phenotyping, 223 rising, 5
Physical and occupational therapy trends in the United States, 64
education in, 207–208 Prevention of pain. See Pain prevention
not covered by insurance, 296 Primary care physicians, 9, 116–117
rehabilitative, 133–134 education challenges of, 154–155, 163,
Physical conditioning programs, 133 196–198
Physical health, impact of pain on, 31–32 first step for many patients, 8, 116, 150
Physician-patient communication, 68, 126, protocols to guide, 155–156
137, 152 shortage of, 148, 197
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INDEX
Principles. See Underlying principles lowering costs for, 100
Problem-solving ability potential projects for, 248–250
deficits in, 88 Public understanding of pain, 63
of teams, 198
Productivity, effects of pain on, 86–87
Q
Project STEP, 246
Projects for public–private partnerships,
Quality improvement (QI) model, 160, 196
potential, 248–250
Quality of life, effects of pain on, xi, 87–88,
Provider attitudes and training, a barrier to
139
effective pain care, 153–156
Quotations from pain sufferers, 19, 24, 26, 32,
Psychiatric disorders, 265
59, 85, 113, 142, 158, 179, 190, 238,
Psychological stressors, 37
293–300
as factors in pain, 25
Psychological therapies, for treating people
with pain, 114, 132–133, 227
R
Psychological traits, assessment of, 237–238
Psychology, education in, 204–206 Racial and ethnic factors, 66–73, 89–90
Psychosocial approaches African American, 67–70
assessment of dimensions of pain, 236–237 American Indians and Alaska Natives,
assessment of psychological traits and 72–73
states related to pain adjustment, Asian Americans, 71–72
237–238 Hispanics, 70–71
ongoing assessment and monitoring of pain Randomized controlled trials (RCTs),
and pain-related states, 238 228–230
opportunities in, 127, 133, 223 failures of, 229–230
research in, 220, 236–238 Recommendations and findings, 4–13, 100
shortfalls in applying in practice, audiences for, 23, 57
226–227 Reengineering the Clinical Research
PsycINFO, 282 Enterprise, 241
Public education, 184–190 Referred pain, 35, 279
Public education campaigns on low back pain, Registries, 234–236
185–186 Regulatory barriers, to effective pain care, 157
Australia, 97, 185–186 “Regulatory science,” defined, 224
Canada, 186 Regulatory Science Initiative, 224
Norway, 186 Rehabilitation Institute of Washington, 161
Scotland, 186 Rehabilitative therapy, for treating people with
Public health-based approach. See also Pain as pain, 114, 133–134
a public health challenge Reimbursement policies
costs and savings from a public health inadequate, 10, 156, 226
approach, 100 need to revise, 10, 121, 164
other public health considerations, 99 written public testimony on, 298–299
potential roles for, 95–100 Reinecke, Peter, 239
public health defined, 55 Reinjury, fear of, 42
role in prevention, 95–98 Relaxation techniques, 132
support for multimodal efforts, 98–99 Religious judgment, 46
value of, 3 Report, organization of, 49
Public meetings, 282–291. See also Written Reporting of pain, 150–152
public testimony Research
Public–private partnerships (PPPs), 243, blueprint for transforming, 14–17, 269–275
245–250 potential savings from improvements in,
current, 245–248 100
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Research challenges, 56, 217–258 Restoration techniques, 134
Annex 5-1: Mechanisms, models, Richard, Patrick, 301–337
measurement, and management in Risk, 26–31
pain research funding opportunity Risk Evaluation and Mitigation Strategy
announcement, 259–267 (REMS), approach to opioids, 142–143
biobehavioral pain, 261 Roadmap for Medical Research, 237, 241
building the research workforce, 238–239 New Pathways to Discovery, 241
diagnosis and assessment of pain, 262–263 Reengineering the Clinical Research
epidemiology of pain, 264–265 Enterprise, 241
expanding basic knowledge, 220–223 Research Teams of the Future, 241
findings and recommendations, 250–254 Royal College of General Practitioners, 219
fostering public–private partnerships,
245–250
S
genetics of pain, 260
health disparities, 265–266
Sacks, Oliver, 191
improving and diversifying research
Sample, of the economic costs of pain,
methods, 228–238
304–305
models of pain, 262
Saunders, Cecily, 139–141
molecular and cellular mechanisms of
Savings from a public health approach, 100
pain, 259–260
Scientific Management Review Board
moving from research to practice, 224–228
(SMRB), 240
need for longitudinal, 13
Scope of the problem of pain, 59–64
obtaining federal research funding,
data sources and limitations, 59–61
244–245
overall prevalence, 61–64
organizational alternatives, 241–243
Scotland, public education campaign on low
organizing research efforts, 239–243
back pain, 186
pain management, 263–264
Self-care, facilitation of, 4
research objectives, 259
Self-efficacy, 44, 279
a road not taken, 239–241
Self-management of pain, 8, 44, 114, 116–117
translational pain research, 266–267
promoting and enabling, 162, 227
Research methods
Self-reporting of pain, 236
comparative effectiveness research,
Sensitivity, declining in the elderly, 79
observational studies, and
Sensitization, 33, 36, 279
psychological research, 232–234
Seriousness of pain, 85–90
improving and diversifying, 228–238
differences in the seriousness of pain by
initiatives to address limitations of clinical
race/ethnicity and sex, 89–90
trials, 230–232
effects on activities of daily living, 86
observational studies, databases, and
effects on productivity, 86–87
registries, 234–236
effects on quality of life, 87–88
psychosocial research, 236–238
effects on the risk of suicide, 88–89
randomized controlled trials: the gold
Serotonin, 40
standard, 229–230
Sex
Research results, 303, 309–313
differences in the seriousness of pain by,
incremental costs of health care, 309–311
89–90
indirect costs of health care, 311–312
disparities in prevalence and care by,
total direct cost for medical care for pain
75–77
diagnoses, 312–313
Shingles, 79
Research Teams of the Future, 241
Shoulder replacement surgeries, 132
Research workforce
Sickle-cell disease, pain associated with, 122,
building, 238–239
295
increasing training of, 13
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INDEX
Sleep disorders, 88 Tockarshewsky, Tina, 59
Social factors in pain, 25 Tolerance. See Pain tolerance
Socioeconomic status, chronic pain inversely Training of primary care physicians, 196–198
related to, 74–75 inadequate, 194
Sources “leading to competency,” 191–192
of acute pain, common, 29 provider attitudes and, 153–156
of chronic pain, common, 29 Transcutaneous electrical nerve stimulation
of data, methods and, 281–291 (TENS), 134
Spinal manipulation, 135 Transforming education, x–xi
St. Jude’s Children’s Research Hospital, 160 blueprint for, 14–17, 269–275
Statistics on pain, 28 Transient receptor potential (TRP) ion
Stem cells, 222 channels, 222
Steps in care, 115–124 Transition, from acute to chronic pain, 29–31
Stereotyping, 78 Translational pain, research in, 266–267
Stigma against pain, 4, 46 Treatment. See also Overtreating people with
Stoicism, “deeply-rooted value and belief in,” pain
71 access to pain care, 127–128
Structural neuroimaging, to investigate pain, value of comprehensive, 3, 22
39 written public testimony on lack of timely,
Structured psychiatric interview methods, 237 296
Subgroups. See Undertreated groups Treatment modalities for pain, 129–137
Subjectivity, of the experience of pain, 25, 223 choice of a treatment approach, 124–127
Substance Abuse and Mental Health Services complementary and alternative medicine,
Administration (SAMHSA), 99, 134–136
145–146 measuring effectiveness of, 192, 227
Substance P antagonists, 300 medications, 129–131
Suffering, protection from and relief of, ix note on the use of placebos, 136–137
Suicide, effects of pain on the risk of, 88–89 overview, 115
Surgeon General, Office of, 56, 189 psychological therapies, 132–133
Surgery, for treating people with pain, 68, 114, regional anesthetic interventions, 131
131–132 rehabilitative/physical therapy, 133–134
Surgical patients, 63 steps in care, 115–124
disparities in prevalence and care for, surgery, 131–132
83–84 written public testimony on the need for
Survey overview, 294 new, 300
System-level barriers, to improved pain care, TRICARE, 5, 93
45 Truman, Harry S, 269
Tufts University School of Medicine, 208
Typology of pain, 32–34
T
Teams, using interdisciplinary approaches, U
121–124
Telephone survey, American Productivity U.K. Department of Health, Chronic Pain
Audit, 86 Policy Coalition, 219
Temporomandibular joint (TMJ) disorders, U.N. Single Convention on Narcotic Drugs,
75, 207 143
Terminal illnesses. See End of life Underlying principles, 3, 20–23
Tissue healing, pain persisting after, 35 chronic pain as a disease in itself, 3, 22
TMJ Association, Ltd., 184, 217, 224 the conundrum of opioids, 3, 22
Tobacco use, campaigns to reduce, 187 importance of prevention, 3, 22
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a moral imperative, 3, 22 White House comprehensive action plan on
need for interdisciplinary approaches, 3, 22 prescription drug abuse, 142
roles for patients and clinicians, 3, 22 Women with Pain Coalition, 189
value of a public health and community- Work disability, 20
based approach, 3 days missed because of selected pain
value of comprehensive treatment, 3, 22 conditions, 325, 334
wider use of existing knowledge, 3, 22 hours lost due to selected pain conditions,
Undertreated groups, 55, 68 335
written public testimony on, 294 Workers’ Compensation, 5, 69, 93, 296
Workers’ Compensation database, 304
Unequal Treatment: Confronting Racial and
Ethnic Disparities in Health Care, 69 World Health Organization (WHO), 47
United Council for Neurologic Subspecialties Constitution, 47
(UCNS), 199 Pain Relief Ladder, 143
University of New Mexico Project ECHO Pain World War II, 82
Clinic, 161 WorldCat, 282
Unknown causes of pain, 34 Written public testimony, 293–300
Urban Indian Health Program (UIHP), 72 conclusion, 300
U.S. Bureau of the Census, 303 difficulties surrounding prescription of
U.S. Medical Licensing Examination, 210 opioids, 297–298
economic burden, 296
the impact of pain, 295
V lack of timely treatment, 296
need for new treatments, 300
Variables, in the economic costs of pain, Q1: on barriers to pain care, 294
305–307 Q2: on improving pain care, 294
Veterans. See also Department of Defense; Q3: on undertreated groups, 294
Department of Veterans Affairs Q4: on experiences seeking treatment for
disparities in prevalence and care for pain, 294
military, 80–82 Q5: on experiences providing pain
Veterinary science, 223 treatment, 294
Vicodin, 146 Q6: additional comments, 294
Vietnam war, 82 reimbursement policies, 298–299
Von Roenn, J. H., et al., 44 summary of, 293–300
Vulnerable populations, 5, 55, 65, 76, 99
Vulvodynia, 75, 137
W
Wages. See Hourly wage reductions
Western Ontario and McMaster Universities
Arthritis Index (WOMAC) pain and
function scale, 231, 237
