Warning that patients shouldn’t assume their doctor has knowledge to treat pain, a national panel of experts has called on medical schools to train doctors and nurses on the basics of pain care, and address pain as a public health crisis. The group insists that without health reforms and better training to diagnose and treat pain properly, people with untreated pain may face a lifetime of pain as a chronic illness—which often leads to job loss, depression and in a number of cases suicide.

“Doctors, who don’t lack for compassion or medical skills, often offer only limited treatments to patients disabled by chronic pain,” said Lonnie Zeltzer, M.D., co-chair of the panel. “With little or no specific training in pain management, and working systems that make it easier to treat common conditions like high blood pressure than a complex problem like pain, doctors may intend to help but leave most patients under-assessed and under-treated. Women, children and minorities often face the highest risk of under-treatment.”

The panel, included anesthesiologists, neurologists, primary care doctors, pediatricians, emergency physicians, nurses, psychologists, pharmacists and patient advocates and was sponsored by the Mayday Fund. After a conference in Washington, D.C. and deliberations over several months the panel’s report, A Call to revolutionize Chronic Pain Care in America: An opportunity in Health Care Reform, says pain is a huge public health problem. They developed a number of recommendations that need to be addressed, by government and the medical community. The report and recommendations have been endorsed by more than 30 organizations, and numerous other signatories from Canada and the U.S. “As we get closer to the possibility of health care reform, the frontlines of medicine—adult and pediatric primary care—could face enormous strains from millions of new patients seeking care for pain,” says Russell K. Portenoy, M.D., panel co-chair and the chairman of Pain Medicine and Palliative Care at the Beth Israel Medical center in New York. “Primary care is the first stop for people in pain, and both the training received by clinicians and the system of care should facilitate best practices in pain care, but this is not the way it is.” The committee writes that chronic pain should be reframed as a chronic illness since “the burden of chronic pain is greater than that of diabetes, heart disease and cancer combined.” People in chronic pain can have longer hospital stays, and many duplicative tests and unproven treatments-all of which drive up costs. Chronic pain costs the nation more than $100 billion a year in lost productivity and direct medical costs, the report said. “This is a wasteful system,” Portenoy adds. “Major reforms in health care are needed if we want to improve the quality and cost-effectiveness of care of chronic illnesses, and pain is as much a chronic illness as diabetes and heart disease.” Although the impact of pain on patients and on society is among the most serious of public health concerns. Chronic pain has been largely left out of the current debate on health reform, the panel writes. According to the report , about “one-third of people in pain report their pain is disabling and has a high impact on their ability to function in daily life. Research suggests that the high cost of under-treated pain includes lost productivity. Pain is the second-leading cause of medically-related work absenteeism, resulting in more than 50 million lost workdays.” If doctors do not recognize chronic pain as a serious illness, or as serious as others, or they perceive that pain complaints cannot, or should not, be treated, persistent chronic pain is the result. In some cases, such as pain in young children and adults with dementia, patients may not report their pain, and under-assessment drives under-treatment. “The tragedy of this system is that it leaves many people suffering from unrelenting pain,” says Zeltzer. “Pain that goes untreated may permanently change the body’s nervous system and may lead to pain that can be managed but never goes away.”

Policymakers have recognized the impact pain has on individuals and the health care system and have recently included provisions in health reform proposals. A bill calls for an Institute of Medicine Conference on Pain; increased funding for the National Institutes of Health to collaborate across institutes to find more effective treatments for pain and to better understand the biology of pain; a grant program to improve health professionals’ understanding of and ability to assess and treat pain; and better public education so that consumers understand the danger of letting pain go untreated. “Remarkably, less than one percent of the NIH budget was devoted to pain in 2008,” Zeltzer said. “This amount is not commensurate with a public health problem of this magnitude.” The situation is no different in Canada with less than 1% of medical research dollars going to pain researchers.

In addition to medical school reforms and expanded funding for pain management programs, the panel cited specific measures that would ease this public health crisis. Among them:
  • Health care providers, insurers and government agencies should eliminate disparities in access to pain care related to race, gender, age and socioeconomic status. Everyone should be offered timely and effective treatment for their pain.
  • Government, health care payers and providers should develop coordinated health information technology (IT) systems to track pain disorders and treatments. Computerized IT systems can boost physicians’ knowledge about the best treatment for pain providing them with best practice information quickly.
  • There should be a reform of reimbursement to eliminate current incentives that drive pain care toward procedures or unproven treatments. Primary care doctors should be reimbursed for the time it takes to provide comprehensive pain care to patients who are disabled by chronic pain—a system that can cost more up front, but often reduces the cost of treating pain over the long haul.
  • · Mount a public education campaign to inform the public about the risks associated with under-treated pain. Consumers should understand that if they wait too long to treat acute pain they run the risk of developing a chronic syndrome, one that’s costly to treat and potentially disabling.

“Reducing the burden of uncontrolled chronic pain is a societal necessity, a medical challenge and an economic requirement,” the panel stated. Source: The Mayday Fund.


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Warning that patients shouldn’t assume their doctor has knowledge to treat pain, a national panel of experts has called on medical schools to train doctors and nurses on the basics of pain care, and address pain as a public health crisis. The group insists that without health reforms and better training to diagnose and treat pain properly, people with untreated pain may face a lifetime of pain as a chronic illness—which often leads to job loss, depression and in a number of cases suicide.

“Doctors, who don’t lack for compassion or medical skills, often offer only limited treatments to patients disabled by chronic pain,” said Lonnie Zeltzer, M.D., co-chair of the panel. “With little or no specific training in pain management, and working systems that make it easier to treat common conditions like high blood pressure than a complex problem like pain, doctors may intend to help but leave most patients under-assessed and under-treated. Women, children and minorities often face the highest risk of under-treatment.”

The panel, included anesthesiologists, neurologists, primary care doctors, pediatricians, emergency physicians, nurses, psychologists, pharmacists and patient advocates and was sponsored by the Mayday Fund. After a conference in Washington, D.C. and deliberations over several months the panel’s report, A Call to revolutionize Chronic Pain Care in America: An opportunity in Health Care Reform, says pain is a huge public health problem. They developed a number of recommendations that need to be addressed, by government and the medical community. The report and recommendations have been endorsed by more than 30 organizations, and numerous other signatories from Canada and the U.S. “As we get closer to the possibility of health care reform, the frontlines of medicine—adult and pediatric primary care—could face enormous strains from millions of new patients seeking care for pain,” says Russell K. Portenoy, M.D., panel co-chair and the chairman of Pain Medicine and Palliative Care at the Beth Israel Medical center in New York. “Primary care is the first stop for people in pain, and both the training received by clinicians and the system of care should facilitate best practices in pain care, but this is not the way it is.” The committee writes that chronic pain should be reframed as a chronic illness since “the burden of chronic pain is greater than that of diabetes, heart disease and cancer combined.” People in chronic pain can have longer hospital stays, and many duplicative tests and unproven treatments-all of which drive up costs. Chronic pain costs the nation more than $100 billion a year in lost productivity and direct medical costs, the report said. “This is a wasteful system,” Portenoy adds. “Major reforms in health care are needed if we want to improve the quality and cost-effectiveness of care of chronic illnesses, and pain is as much a chronic illness as diabetes and heart disease.” Although the impact of pain on patients and on society is among the most serious of public health concerns. Chronic pain has been largely left out of the current debate on health reform, the panel writes. According to the report , about “one-third of people in pain report their pain is disabling and has a high impact on their ability to function in daily life. Research suggests that the high cost of under-treated pain includes lost productivity. Pain is the second-leading cause of medically-related work absenteeism, resulting in more than 50 million lost workdays.” If doctors do not recognize chronic pain as a serious illness, or as serious as others, or they perceive that pain complaints cannot, or should not, be treated, persistent chronic pain is the result. In some cases, such as pain in young children and adults with dementia, patients may not report their pain, and under-assessment drives under-treatment. “The tragedy of this system is that it leaves many people suffering from unrelenting pain,” says Zeltzer. “Pain that goes untreated may permanently change the body’s nervous system and may lead to pain that can be managed but never goes away.”

Policymakers have recognized the impact pain has on individuals and the health care system and have recently included provisions in health reform proposals. A bill calls for an Institute of Medicine Conference on Pain; increased funding for the National Institutes of Health to collaborate across institutes to find more effective treatments for pain and to better understand the biology of pain; a grant program to improve health professionals’ understanding of and ability to assess and treat pain; and better public education so that consumers understand the danger of letting pain go untreated. “Remarkably, less than one percent of the NIH budget was devoted to pain in 2008,” Zeltzer said. “This amount is not commensurate with a public health problem of this magnitude.” The situation is no different in Canada with less than 1% of medical research dollars going to pain researchers.

In addition to medical school reforms and expanded funding for pain management programs, the panel cited specific measures that would ease this public health crisis. Among them:
  • Health care providers, insurers and government agencies should eliminate disparities in access to pain care related to race, gender, age and socioeconomic status. Everyone should be offered timely and effective treatment for their pain.
  • Government, health care payers and providers should develop coordinated health information technology (IT) systems to track pain disorders and treatments. Computerized IT systems can boost physicians’ knowledge about the best treatment for pain providing them with best practice information quickly.
  • There should be a reform of reimbursement to eliminate current incentives that drive pain care toward procedures or unproven treatments. Primary care doctors should be reimbursed for the time it takes to provide comprehensive pain care to patients who are disabled by chronic pain—a system that can cost more up front, but often reduces the cost of treating pain over the long haul.
  • · Mount a public education campaign to inform the public about the risks associated with under-treated pain. Consumers should understand that if they wait too long to treat acute pain they run the risk of developing a chronic syndrome, one that’s costly to treat and potentially disabling.

“Reducing the burden of uncontrolled chronic pain is a societal necessity, a medical challenge and an economic requirement,” the panel stated. Source: The Mayday Fund.


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