RSDSA :: Reflex Sympathetic Dystrophy Syndrome Association

National Panel Sounds Alarm About Lack of Physician Training to Treat Chronic Pain; Major Health Groups Endorse New Report Which Calls for Urgent Medical School and Health System Reform

“Epidemic” of undertreatment affects more than 70 million Americans suffering from persistent back pain, headaches, joint pain; disproportionately affects minorities and low income

WASHINGTON, DC (November 4, 2009)-- Warning that patients shouldn’t assume their doctor has enough knowledge to treat their pain, a national panel of experts today called on medical schools to train doctors and nurses on the basics of pain care, reform the nation’s reimbursement system, 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 could lead to job loss, depression and in some cases, even 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, and the director of the Pediatric Pain Program at the University of California, Los Angeles. “With little or no specific training in pain management, and working in systems that make it much 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. Minorities, children and women often faced the highest risk of under-treatment.”

The panel, convened by the New York City-based Mayday Fund, included anesthesiologists, neurologists, primary care doctors, pediatricians, emergency physicians, nurses, psychologists, pharmacists and patient advocates (the full list is included below). After a conference in Washington D.C. and deliberations that lasted 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 several recommendations for government agencies, Congress and the medical community to address.

The report and recommendations have been endorsed by more than 30 organizations, including the American Academy of Family Physicians, American Academy of Pediatrics, The Joint Commission, American Nurses Association, American College of Emergency Physicians, and the American Academy of Neurology (the list of current signatories is below).

“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 Mayday Fund Special Committee on Pain and the Practice of Medicine 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 have longer hospital stays, and many duplicative tests and unproven treatments—all of which drive up the nation’s health care spending, the panel said.

Chronic pain costs the nation more than $100 billion a year in lost productivity and direct medical costs, the report says. “This is a wasteful system,” Portenoy adds. “Major reforms in the health care system are needed if we want to improve the quality and cost effectiveness of care for 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 national debate on health reform, the panel writes.

The authors pay particular attention to the numerous studies that suggest low-income populations, minorities, women and children are more likely to be under-treated for pain or not receive pain care at all. 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 pain results. 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.”

Federal policymakers have recognized the impact pain has on individuals and the health care system and have included provisions of the National Pain Care Policy Act 2009 (NPCPA) in health reform proposals. That 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.”

In addition to medical school reforms and expanded funding for pain management training 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. All Americans in pain, including low-income Americans, should be offered timely and effective treatment for their pain.
Government, health care payors 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 by providing them with best practice information quickly.
The Department of Health and Human Services should reform payment to eliminate the 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 a little more up front, but often reduces the cost of treating pain over the long haul.
The Surgeon General should 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 says.

The Mayday Fund is a New York City-based private philanthropy dedicated to alleviating the incidence, degree and consequences of human physical pain. The Mayday Fund does not lobby or retain individuals or organizations to lobby. The panel participants are listed below. To obtain a copy of the report please visit www.MaydayPainReport.org.

THE MAYDAY FUND SPECIAL COMMITTEE ON PAIN AND THE PRACTICE OF MEDICINE
COMMITTEE CO-CHAIRS
Russell K. Portenoy, MD
Chair, Department of Pain Medicine & Palliative Care, Beth Israel Medical Center
Professor of Neurology & Anesthesiology, Albert Einstein College of Medicine
Lonnie Zeltzer, MD
Professor of Pediatrics, Anesthesiology, Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, and Director, Pediatric Pain Program, Mattel Children’s Hospital, UCLA
Associate Director, Patients & Survivors Program, UCLA Jonsson Cancer Center

COMMITTEE MEMBERS
James N. Campbell, MD
Professor of Neurosurgery, Johns Hopkins University
Nancy Eksterowicz, RN, BC, MSN
Immediate Past President, American Society for Pain Management Nursing
Scott M. Fishman, MD
President & Board Chair, American Pain Foundation
Chief, Division of Pain and Professor of Anesthesiology & Pain Medicine, University of California, Davis
Sandra Fitzler
Senior Director of Clinical Services, American Health Care Association
Kathleen M. Foley, MD
Attending Neurologist, Pain & Palliative Care Service and Chief, Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center
Professor of Neurology, Neuroscience & Clinical Pharmacology, Cornell University Medical College
Rollin M. Gallagher, MD, MPH
President, American Academy of Pain Medicine
Clinical Professor of Psychiatry & Anesthesiology, Director for Pain Policy Research & Primary Care, University of Pennsylvania School of Medicine
Carmen R. Green, MD
Professor of Anesthesiology and Obstetrics & Gynecology, University of Michigan School of Medicine
Associate Professor of Health Management & Policy, University of Michigan School of Public Health
Constance S. Houck, MD
Chair, Section on Anesthesiology & Pain Medicine, American Academy of Pediatrics
Senior Associate in Perioperative Anesthesia, Children’s Hospital of Boston
Bill McCarberg, MD
Founder, Chronic Pain Management Program, Kaiser Permanente San Diego
Adjunct Assistant Clinical Professor, University of California, San Diego
Patrick McGrath, OC, PhD
Vice President, Research, IWK Health Centre
Professor of Psychology, Pediatrics & Psychiatry, Dalhousie University
Anne Louise Oaklander, MD, PhD
Associate Professor of Neurology, Harvard Medical School
Assistant in Pathology (Neuropathology), Massachusetts General Hospital
Steven D. Passik, PhD
Associate Attending Psychologist, Department of Psychiatric & Behavioral Sciences,
Memorial Sloan Kettering Cancer Center
Associate Professor of Psychology in Psychiatry, Cornell University Medical College
Lisa Robin
Senior Vice President, Member Services, Federation of State Medical Boards
Will Rowe
Chief Executive Officer, American Pain Foundation
Seddon R. Savage, MD, MS
President-Elect, American Pain Society
Director, Dartmouth Center on Addiction, Recovery & Education
Associate Professor of Anesthesiology, Dartmouth Medical School
Pain Consultant, Manchester VA Medical Center
Mary Jean Schumann, MSN, MBA, RN, CPNP
Chief Programs Officer, American Nurses Association
Knox H. Todd, MD, MPH
Director, Pain and Emergency Medicine Institute, Beth Israel Medical Center
Professor of Emergency Medicine, Albert Einstein College of Medicine
Peter VanPelt, RPh
Senior Manager, Corporate Alliances, American Pharmacists Association
Gary A. Walco, PhD
Director of Pain Medicine, Department of Anesthesiology & Pain Medicine, Seattle Children’s Hospital
Professor of Anesthesiology, University of Washington College of Medicine
Robert A. Wise, MD
Vice President, Division of Standards and Survey Methods, The Joint Commission

This report has been endorsed by the following organizations:
Alliance of State Pain Initiatives
American Academy of Family Physicians
American Academy of Hospice and Palliative Medicine
American Academy of Neurology
American Academy of Pain Management
American Academy of Pain Medicine
American Academy of Pediatrics
American Cancer Society Cancer Action Network
American College of Emergency Physicians
American Health Care Association
American Nurses Association
American Pain Foundation
American Pain Society
American Pharmacists Association
American Psychosocial Oncology Society
American Society for Pain Management Nursing
American Society of Law, Medicine & Ethics
American Society of Pain Educators
Association of Oncology Social Work
Association of Professional Chaplains
Center for Practical Bioethics
Center to Advance Palliative Care
Honor Society of Nursing, Sigma Theta Tau International Center for Nursing Excellence in Long-Term Care
International Association for Hospice and Palliative Care
International Psycho-Oncology Society
National Association of Social Workers
National Palliative Care Research Center
Reflex Sympathetic Dystrophy Syndrome Association
The HealthCare Chaplaincy
The Joint Commission
The National Hospice and Palliative Care Organization