Improved Education, Consistent Policies, and Better Communication Are the Cornerstones of Effective Pain Management

MDNG Pain Management, March/April 2009, Volume 2, Issue 2

An important part of the American Pain Foundation's mission is to improve the quality of life of people with pain by advocating for the removal of barriers that impede access to effective pain management.

With an estimated 76.5 million Americans struggling with persistent chronic pain, there is no doubt that pain is woefully undertreated. An important part of the American Pain Foundation’s (APF) mission is to improve the quality of life of people with pain by advocating for the removal of barriers that impede access to effective pain management. The promotion of improved pain management practices is a critical part of this equation. APF, in partnership with key national pain experts, has identified core areas that must be addressed, including the integration of pain education in professional training, the advancement of balanced pain-related regulatory policies, and the promotion of open communication between healthcare providers and patients living with pain.

As one of the most common reasons someone will seek medical care, pain is commonly reported as a primary chief complaint and frequently seen in the primary care practice setting. However, most healthcare professionals have not been trained in pain management, resulting in pain often being poorly assessed in most practice settings and looked upon as merely a symptom of other medical disorders. Marginalizing pain results in needless suffering and poor patient care outcomes. Untreated acute pain can lead to irreversible damage to the CNS; the disease of chronic pain evolves.

Some providers refer those with pain complaints, no matter the cause, to a pain specialist. With approximately one pain specialist for every 21,000 patients, access to specialized pain management care is limited, forcing those in pain to either delay pain care, doctor shop in a desperate attempt to find care, or purchase medications from dubious sources.

It is critical to have pain management training included in the core curriculums of schools of medicine to ensure that healthcare professionals have the skill set and resources to properly assess someone with pain and provide quality pain management. Providers must be prepared to understand how pain can influence all aspects of a person’s life and be able to recognize the signs of addictive disease or problematic behaviors without the fear that treating pain appropriately can cause or feed an addiction.

Policies and procedures

In addition to improving professional education, universal regulatory policies need to be adopted. The perpetuation of myths and misconceptions about pain, its treatment, the obligation of medical ethics, and the medico-legal impact on practice fuels private and hospital practice policies. Physicians’ fears of being investigated or disciplined by state and federal regulatory agencies—particularly around the appropriate use of opioids to manage persistent chronic pain—have proven fertile ground for this dilemma. Physicians may feel that the need to protect their practice and livelihood takes precedence over the best interest of the person in pain; this significantly undermines the tenants of medical ethics and increases patient suffering.

State medical boards’ regulatory processes are often confusing, which can restrict a practitioner’s ability to appropriately prescribe for pain management. Though in existence since 2002 as a guideline and established as a policy in 2004, the Federation of State Medical Boards Model Policy for the Use of Controlled Substances for the Treatment of Pain has yet to be adopted in all 50 states. Several state professional boards have used this policy as a cornerstone to develop a consensus document, yet integration into the practice setting has been hampered due to poor implementation strategies.

How effective is the communication between the healthcare professional and the person with pain? In September of 2008, a nationwide survey found that a sizable gap exists between patients and healthcare professionals when it comes to understanding and discussing pain. Ineffective communication contributes to the complexity of pain care and leads to the under-treatment of pain. Personalized conversations about the pain experience and the impact on daily living are critical. Research has found that simply acknowledging a person’s pain can have profound therapeutic results.

Let’s Talk Pain

To address the communication gap, a group of leading pain management organizations have formed the Let’s Talk Pain Coalition. The purpose is to unite the perspectives of people with pain, caregivers, and healthcare providers and encourage them to "Talk, Listen and Act" to help improve overall pain care.

As the 75 million baby boomers move toward retirement, the epidemic of chronic pain is expected to grow at an alarming rate, with the economic toll of pain exceeding more than $100 billion each year. The bottom line is that people in pain have a right to timely, effective care. The APF will continue its mission of improving the quality of life of people with pain by raising awareness, providing practical information, promoting research, and advocating to remove barriers and increase access to safe and effective pain management.

Will Rowe is Chief Executive Officer of the American Pain Foundation.