Across health care and society alike, there are major gaps in knowledge about pain. Educating health professionals about how to better understand pain and its causes will help bridge these gaps.
To improve patient and public understanding of pain, federal agencies and other stakeholders should redesign education programs. They should aim to foster an understanding among patients, the public, and healthcare providers that there are complex biological and psychosocial aspects to pain, and they should develop materials about the nature of pain; ways to use self-help strategies to prevent, cope with, and reduce pain; and available treatments for pain. The materials should be specifically targeted to patients, the public, and healthcare providers.
To increase understanding among the array of health professionals who deal with pain, undergraduate and graduate training programs should offer standardized information about pain and include experience in caring for pain in interprofessional settings. Improving education is especially important for primary care providers, given their key role in pain management. In addition, all care providers should keep their knowledge current by engaging in continuing education programs; and licensure, certification, and recertification examinations should include assessments of providers’ pain education.
Research has made remarkable strides in understanding the biological, cognitive, and psychological underpinnings of pain, and the future promises advances in a number of fields—from genomic and cellular through behavioral mechanisms. Still, many gaps persist, and developing more effective and less risky pain relievers remains a major challenge. Additional challenges exist when trying to use advances in the implementation sciences to help translate effective treatments from research into practice and to adapt the regulatory process to enable more efficient evaluation and approval of potentially effective therapies. This will be especially important as personalized medicine approaches to pain management develop. At present, however, federal dollars for pain research are in short supply and likely to decrease. Moreover, the responsibility for pain research is spread thin.
The committee recommends that an existing NIH institute be designated the lead institute for pain. It also recommends that the NIH Pain Consortium take a stronger leadership role in effecting the necessary transformation in how pain research is conducted, by fostering coordination across institutes and centers, by improving study section decision making on pain proposals, and by exploring a range of potential public-private initiatives.
The need for pain-related research is not confined to the NIH. Research into the prevention, occurrence, and costs of pain and the delivery and financing of pain treatment are of concern to many public health entities, for example, the Centers for Disease Control and Prevention, for epidemiological data and public education strategies; AHRQ, for quality improvement; the Health Resources and Services Administration, with respect to professional education and service delivery for vulnerable populations; and the Centers for Medicare and Medicaid Services, for reimbursement-related research and demonstration programs.
Blueprint for Action
The committee offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. The blueprint prioritizes the committee’s recommendations. While some recommendations should be implemented by the end of 2012—including developing a comprehensive strategy, developing strategies to reduce barriers in care, supporting collaboration between pain specialists and primary care clinicians, and designating a lead institute at the NIH that is responsible for moving pain research forward—all other recommended actions must build on these shortterm achievements and should be taken soon afterward. These other actions must be ongoing efforts that should be firmly developed and put in place by the end of 2015.
The strategy should be comprehensive in scope, inclusive in its development, expeditious in its implementation, and practical in its application. Most importantly, the strategy must be farreaching. As evidenced in this report, pain is a major driver for visits to physicians and other healthcare providers, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.