Usually I write about topics that can make a reader weep.
Today I want to write about hope — hope that a group of professionals will bring about a “cultural transformation” in pain care in the United States.
The Pain Action Alliance to Implement a National Strategy (PAINS) is a group of professionals and interested parties who came together to work out a way to implement the recommendations of the Institute of Medicine (IOM). The IOM’s landmark 2011 report, Relieving Pain in America, states that “addressing the enormous burden of pain will require a cultural transformation…Effective pain management is a moral imperative, a professional responsibility and the duty of people in the healing professions.”
Over the next five years, PAINS will develop an action plan — a vision for the future of integrated pain care. Myra Christopher, the Kathleen M. Foley Chair for Pain and Palliative Care at the Center for Bioethics, told me the concept of integrated care has been around for several years. She says the PAINS model will include “a bio/psycho/social approach to the treatment of chronic pain, more research into pain and its treatment, and a concerted effort to educate the public about the IOM’s report.”
The IOM report states that there are 100 million Americans who suffer from chronic pain. While it’s hard to judge the severity of pain in that figure, Ms. Christopher believes many do suffer badly. She also explained that the estimate of 100 million doesn’t include children, nursing home residents and veterans. Many believe the actual number of people in pain is higher — making the PAINS policy formation a moral and ethical imperative.
In addition to working on the implementation of the IOM’s recommendations, PAINS is currently developing a website for people with pain. This site is designed with the goal of giving people with pain the kind of content, policy initiatives, guidelines for treatment and clinical information. It is hoped that this site will be a place where people with pain can go for information that is currently scattered.
PAINS will also try to develop plans for medical education that currently fail to prepare physicians to treat chronic pain. Most physicians are not being trained adequately in our medical schools to treat moderate to severe pain with opioid analgesics. Yet many providers prescribe theses medicines, often as a front-line treatment. PAINS’ integrated model of pain treatment should help standardize pain treatment, while giving health care providers the tools to treat the whole person, not just the prescription treatment of pain.
Alternative Pain Treatments
The problem right now with pain treatment in the U.S. is the refusal of many insurance companies to cover alternative methods of treatment, including therapeutic massage, meditation, acupressure, and acupuncture. Granted, much research needs to be done on these alternative methods, but what has been done so far shows they have promise.
One hopes that PAINS’ work on treatment guidelines and education will put pressure on the insurance companies to include coverage of alternative medicine. If these methods were more available to people with pain, the overall costs of treatment could fall for insurance companies as patients and their providers embrace the integrated model of pain treatment.
One of the drivers of the oppression of pain patients is our fractured medical care. With no real accepted standards of treatment and a lack of pain education in our medical schools, we now have physicians refusing to treat pain patients and pharmacies too frightened by the Drug Enforcement Administration to meet their moral imperative to fill opioid prescriptions for people living with unrelenting pain.
This becomes particularly pernicious as those of us who’ve become disabled by pain fall down the socioeconomic ladder as we lose our income. Many of us also lose our insurance and forego or delay much needed treatment. As a result, medical care is decreasingly available. This becomes a class issue as those with good incomes can afford treatment, while those who have fallen out of the middle class get less treatment. All one has to do is look at what has happened in Washington state, Florida, Ohio and now Texas to see the impact of fractured medical policy.
The implementation of the IOMs report by PAINS should go a long way towards correcting this problem. And over the next few years, Obamacare should help those who’ve lost their insurance due to pre-existing conditions.
My one concern is that as these very real changes are introduced that the combined political power of health insurers, hospital corporations and their representatives in both state and federal legislatures will try to water down or destroy the reforms before they can be implemented. Knowing that this is possible, pain patients need to be vigilant and apply more pressure on the government and non-governmental groups, such as Physicians for Responsible Opioid Prescribing (PROP).
It may be time for pain patients themselves to organize and to militantly confront the government — especially the DEA, and state and federal prosecutors who are leading efforts to oppress people with pain.
I realize that waiting five years for PAINS to do its work seems like an eternity for those who suffer relentless pain. But in the scheme of things, this is a short period when considering that the IOM and PAINS are working on nothing less than cultural change in the treatment of pain. We should support their work whenever and wherever we can; the integrated model of treatment looks to be the best model available to us.