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