The First National Pain Medicine Summit—Final Summary Report

Abstract

Pain is ubiquitous. At some point in time it affects everyone. For many millions pain becomes chronic, a scourge that impacts every facet of life-work, hobbies, family relations, social fabric, finances, happiness, mood, and even the very essence of identity. According to the National Institutes of Health (NIH), pain is one of our most important national public health problems, a silent epidemic. In 1998, NIH reported that the annual amount spent on health care, compensation, and litigation related to pain had reached one hundred billion dollars ($100,000,000,000). Considering that health care costs have doubled since then, it is not unreasonable to assume that the costs related to pain care have doubled as well. Millions of patients suffer needlessly with acute pain, with cancer pain, and with chronic pain. The ineffective management of pain results in an escalating cascade of health care issues. Acute pain that is not treated adequately and promptly results in persistent pain that eventually causes irreversible changes in the nervous system. This translates into progressive bio-psycho-social epiphenomena resulting in further pain and disability. It creates a vicious cycle transforming a functional human being into an invalid who becomes a burden to family, to society, and to oneself. In the face of adequate medical science, adequate technical skills, and adequate resources the reality of delayed and inadequate pain care is paradoxical. This dilemma deserves close scrutiny and effective remediation. The American Medical Association (AMA), long dedicated to the need to improve pain care in this country, has been faced with this reality. It was from this vision that the idea of holding a Pain Medicine Summit was conceived. Resolution 321 (A-08) set in motion a process that would bring together a diverse group of stakeholders for the purpose of discussing the present and future status of pain care; a process that culminated in a broad-based coalition of physicians and organizations dedicated to improving pain care, the first National Pain Medicine Summit. The process began with the adoption of Resolution 321 (A-08) at an AMA Annual House of Delegates meeting in June 2008. Resolution 321 (A-08) states, in part, that "...the AMA encourages relevant specialties to collaborate in studying: 1) the scope and practice and body of knowledge encompassed by the field of Pain Medicine; 2) the adequacy of undergraduate, graduate, and post graduate education in the principles and practices of the field of Pain Medicine, considering the current and anticipated medical need for the delivery of quality pain care; and 3) appropriate training and credentialing criteria for this multi-disciplinary field of medical practice." The next step was delegating the responsibility for implementing Resolution 321 (A-08) to the Pain and Palliative Medicine Specialty Section Council (PPMSSC). The PPMSSC, under the direction of its chairman, Philipp M. Lippe, MD, FACS, assumed responsibility in November 2008 for identifying a process that would a...

Defining Racial and Ethnic Disparities in Pain Management

“…As evident from the summary statement of the recent National Pain Medicine Summit [57], it is widely Clinical studies: controlling for sociodemographic characteristics and medical comorbidity, most studies show no racial differences in pain intensity ratings [31,78,83] Immediate response of unpleasantness; immediate affective response; limited cognitive processing Experimental and clinical studies: African Americans describe comparable pain intensity as a more unpleasant sensation than whites [30,61,78] Racial disparities in pain unpleasantness differ across painful medical conditions, including AIDS [12], glaucoma [84], and arthritis [25] Longer-term reflective cognitive processes relate to meanings pain holds for one's life; negative emotions, eg, depression, anxiety, fear, anger…”

“…A large undertaking, pain medicine physicians and advocacy groups for pain patients have begun this work through such organizations as the American Academy of Pain Medicine, the American Pain Foundation, and the American Pain Society. As noted in the summary of the National Pain Medicine Summit [57], the American Academy of Pain Medicine has taken on a leadership role in addressing these and other needs. Their primary recommendations, as articulated in the recently published ''Pain Medicine Position Paper'' [29], include ''[r]ecognizing pain medicine as a primary medical specialty by the American Board of Medical Specialties…[and p]roviding a comprehensive system of pain care delivery that excels by integrating diverse medical specialties in the research, diagnosis, and treatment of pain'' (p 977).…”

“…Even if patients could accurately describe the culturally idiosyncratic attitudes and beliefs about pain and the experiences that influence their responses to pain stimuli, few clinicians have time during a clinical encounter to ask about them. (4) While opioid analgesics are only one of several pain treatment modalities included in the biopsychosocial model of pain management articulated by Gallagher [35] and now being recommended as the model for pain care at the Veterans' Affairs [57], the careful use of such drugs has been endorsed for relief of acute postoperative cancer and chronic nonmalignant pain by professional and public health agencies including the American Academy of Pain Medicine [22], the American Pain Foundation [1], and the World Health Organization (WHO) [106]. Assumed and empirically documented risks of abuse, dependency, or medication diversion have made many physicians fearful and reluctant, or even unwilling, to prescribe opioids [5,8,13].…”

Pediatric Pain Management Education in Medical Students: Impact of a Web-Based Module

“…[7][8][9][10] Effective pain management begins with well-trained health care providers, as is supported in recent reports from both the Institute of Medicine (IOM) and the American Medical Association's Pain and Palliative Medicine Specialty Section Council, which emphasize the need for pain management education in both medical schools and graduate medical education programs. 11,12 To address the need for a more comprehensive medical education on pediatric pain, we developed and pilot-tested a web-based educational program: the Pediatric Pain Management (PPM) module. Our premise was that medical students should be provided with basic knowledge of pain management in children.…”

Teaching Chronic Pain in the Family Medicine Residency

“…9 Despite the high patient demand for pain management services and the benefits of having primary care physicians manage their own patients, training in pain management is inadequate at both the medical school 11,12 and residency levels. 11,13 A majority of practicing physicians rated their pain management training as inadequate, 14 and confidence in their ability to treat chronic pain is low. 15 A survey of residents found that only 17% felt "confident" or "very confident" in their ability to treat patients with chronic …”