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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Appendix A


Data Sources and Methods

The Committee on Advancing Pain Research, Care, and Education was asked to assess the current state of the science with respect to pain research, care, and education and explore approaches to advancing the field. The purpose of this study was to review the public heath significance of pain; identify barriers to appropriate pain care and strategies for reducing those barriers; identify populations undertreated for pain; identify tools and strategies for enhancing training of pain researchers; and examine opportunities for public–private partnerships to support pain research, care, and education. To respond comprehensively to its charge, the committee examined data from a variety of sources. These sources included a review of the recent literature, public input obtained through a series of meetings, a commissioned paper, and written public comments on aspects of the study charge. The study was conducted over a 10-month period.

DESCRIPTION OF THE STUDY COMMITTEE

The study committee comprised 19 individuals with expertise in pain research, pain management, pharmacology, the behavioral sciences, clinical specialties (pediatrics, oncology, infectious disease, neurology, neurosurgery, anesthesiology, pain medicine, dentistry, and complementary medicine), chronic disease, clinical teaching, epidemiology, ethics, and consumer education, as well as those who have suffered personally from chronic pain and could reflect the perspectives of the many people affected by pain. See Appendix D for biographical sketches of the committee members. The committee convened for five 2-day meetings in November 2010, January 2011, February 2011, March 2011, and April 2011.

Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×

LITERATURE REVIEW

Several strategies were used to identify literature relevant to the committee’s charge. First, a search of bibliographic databases, including MEDLINE and PsycINFO, was conducted to obtain articles from peer-reviewed journals. In addition, WorldCat and the New York Academy of Medicine’s Grey Literature database was searched for books, reports, and other types of grey literature. The searches focused on pain epidemiology, assessment, treatment, education, and training. The keywords used included pain and diagnosis, treatment, management, analgesics, drug prescriptions, complementary therapies, practice patterns, public health, epidemiology, chronic disease, acute pain, communication barriers, physician-patient relations, caregivers, health services accessibility, health knowledge and attitudes, health care delivery, education (medical, continuing, graduate, internship and residency, nursing, pharmacy, psychology, public health professional, nonprofessional, non-medical, professional development, professional standards), curriculum, ethnic groups, population groups, aged, child, cognition disorders, women, sex factors, comorbidity, disparities, racial and ethnic differences, stereotyping, psychology, research (behavioral, biomedical, genetic, translational, interdisciplinary, qualitative, empirical), food and drug administration, department of veterans affairs, military medicine, department of defense, and public-private sector partnerships. Staff sorted through approximately 3,500 articles to identify those that were relevant to the committee’s charge and created an EndNote database. In addition, committee members, meeting participants, and the public submitted articles and reports on these topics. The committee’s database included more than 2,600 relevant articles and reports.

PUBLIC MEETINGS

The committee hosted four public meetings to obtain additional information on specific aspects of the study charge. These meetings were held in conjunction with the committee’s November, January, February, and March meetings. The committee determined the topics and speakers for the public meetings. The committee also held open forums at each public meeting at which members of the public were encouraged to provide testimony on any topics related to the study charge.

The first meeting was intended to focus on a discussion of the committee’s task. Representatives from the study’s sponsors reviewed and discussed the charge to the committee. The second meeting focused on data collection on pain and opportunities for public–private partnerships. The third meeting featured speakers who discussed cultural and anthropological views on pain and financing of pain care. The final meeting addressed the basic science of pain and its translation to clinical practice, as well as the regulation of pain drugs. At each meeting, the committee heard testimony and comments from a broad range of stakeholders,

Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×

including individuals living with pain, family members of people living with pain, health care providers, representatives of the pharmaceutical industry, and individuals representing pain advocacy groups. The committee found this input to be highly informative for its deliberations. Agendas for the four meetings are presented in Boxes A-1 through A-4.

In addition to testimony at these meetings, the committee solicited public input on topics relevant to its charge through its website. More than 2,000 individuals provided written testimony. A summary of these comments can be found in Appendix B.

COMMISSIONED PAPER

The committee commissioned a paper on the economic burden of pain. The specific aim of this work was to provide an assessment of the economic and societal costs of pain and pain care, including such topics as health care expenditures, out-of-pocket costs, costs related to lost work or unemployment, and other individual-level impacts (see Appendix C).

Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×

BOX A-1
Committee on Advancing Pain
Research, Care, and Education

The National Academies Keck Building
500 Fifth Street N.W.
Washington, D.C.

AGENDA FOR PUBLIC SESSIONS
Monday, November 22, 2010
Room 201

1:00 p.m. WELCOME AND INTRODUCTIONS
 
Philip A. Pizzo, M.D.
Chair
 
1:15 p.m. DELIVERY OF STUDY CHARGE
 
Lawrence A. Tabak, D.D.S., Ph.D.
NIH Principal Deputy Director
 
1:30 p.m. DISCUSSION OF STUDY CHARGE WITH SPONSOR
 
2:30 p.m. ADJOURN OPEN SESSION
Tuesday, November 23, 2010 Room 100
 
9:00 a.m. WELCOME AND COMMITTEE INTRODUCTIONS
 
Philip A. Pizzo, M.D.
 
9:15 a.m. STAKEHOLDER PERSPECTIVES
 
Tina M. Tockarshewsky
President and CEO
The Neuropathy Association
 
Terrie Cowley
President
The TMJ Association, Ltd.
 
Peter Reinecke
Principal
Reinecke Strategic Solutions, Inc.
Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×
Gwenn Herman, LCSW-C, DCSW
Executive Director
Pain Connection
Chronic Pain Outreach Center, Inc.
 
Malcolm Herman, Esq.
The American Pain Foundation
 
Romy Gelb-Zimmer, MPP
Associate Director
Federal Regulatory and Payment Policy
American Academy of Nurse Anesthetists
 
Robert J. Saner
Principal
Powers, Pyles, Sutter & Verville PC
 
11:30 a.m. ADJOURN
Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×

BOX A-2
Committee on Advancing Pain

Research, Care, and Education

The National Academies Keck Building
500 Fifth Street N.W.
Washington, D.C.

AGENDA FOR PUBLIC SESSION
Tuesday, January 4, 2011
Room 101

10:00 a.m. WELCOME AND INTRODUCTIONS
 
Philip A. Pizzo, M.D., Chair
10:10 a.m. PUBLIC COMMENTS
 
Michael Ashburn, M.D., M.P.H.
 
American Pain Society (APS) and
 
American Society of Anesthesiologists (ASA)
11:00 a.m. DATA COLLECTION ON PAIN AT THE FEDERAL LEVEL
 
Centers for Disease Control and Prevention, National Center for Health Statistics
Jennifer Madans, Ph.D.
Co-Deputy Director
Associate Director for Science
 
Veterans Health Administration
Lynette Nilan, R.N., Ed.D.
Director, Strategic Planning and Measurement
Patient Care Services
 
Michael E. Clark, Ph.D.
Clinical Director, Pain Rehabilitation Program
James A. Haley Veterans Hospital, Tampa
 
Department of Defense
CDR Necia Williams, M.C., United States Navy
Chief, Integrated Anesthesia Services
Walter Reed Army Medical Center
National Naval Medical Center
Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×
LTC Scott R. Griffith, M.D., United States Army
Consultant, Pain Management
Walter Reed Army Medical Center
12:30 p.m. BREAK FOR LUNCH
 
Committee will meet in closed session for lunch. Members of the public may obtain lunch in the cafeteria located in the third floor Atrium.
1:15 p.m. PUBLIC–PRIVATE PATNERSHIPS
 
Robert Dworkin, Ph.D.
University of Rochester Medical Center
Director, Analgesic Clinical Trial Innovations, Opportunities, and Networks (ACTION), a public-private partnership with the FDA
 
Story C. Landis, Ph.D.
Director, National Institute of Neurological Disorders and Stroke
2:15 p.m. PUBLIC COMMENTS
 
Andrew Bertagnolli
American Chronic Pain Association
 
Penney Cowan
Founder, Executive Director
American Chronic Pain Association
 
David St. Peter, M.D., F.H.M.
Society of Hospital Medicine and Pacira Pharmaceuticals, Inc.
 
Carol Drury
Associate Director
Endometriosis Association
 
Chip Amoe
Assistant Director, Federal Affairs
American Society of Anesthesiologists
 
2:45 p.m. ADJOURN OPEN SESSION
Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×

BOX A-3
Committee on Advancing Pain
Research, Care, and Education

Hotel Monteleone
214 Royal Street
New Orleans, LA 701302201

AGENDA FOR PUBLIC SESSIONS
Tuesday, February 8, 2011

10:00 a.m. WELCOME AND INTRODUCTIONS
 
Philip A. Pizzo, M.D., Chair
 
10:10 a.m. CULTURAL VIEWS OF PAIN
 
David B. Morris, Ph.D.
Emeritus Professor of English
University of Virginia
 
Mary-Jo DelVecchio Good, Ph.D.
Professor of Social Medicine
Harvard Medical School
 
Linda Garro, Ph.D.
Professor
Department of Anthropology
University of California, Los Angeles
 
12:00 p.m. COMMITTEE WILL MEET IN CLOSED SESSION FOR LUNCH
 
1:00 p.m. FINANCING AND RESOURCES FOR PAIN CARE
 
Jeffrey Livovich, M.D.
Medical Director, Aetna Inc.
National Medical Policy and Operations
 
2:00 p.m. PUBLIC COMMENTS
 
Todd Sitzman, M.D.
Medical Director
Advanced Pain Therapy, LLC
 
Barbara St. Marie, MA, RN-BC, CS, ANP, GNP
Nurse Practitioner Healthcare Foundation
Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×
Harry Gould, M.D.
Professor
Department of Neurology
LSU Health Sciences Center
 
Dennis Paul, M.D.
Associate Professor
Department of Pharmacology
LSU Health Sciences Center
 
Art Morelli, M.D.
Vice President, Medical Affairs
Clovidien Pharmaceuticals
 
Philip A. Saigh, Jr.
Executive Director
American Academy of Pain Medicine
 
Angie Gravois
Patient and Nurse, Picayune, Mississippi
 
Janet Chambers
President
Association for Fibromyalgia and Chronic Pain
 
Jon Russell, M.D., Ph.D.
Associate Professor
Department of Medicine
University of Texas Health Science Center at San Antonio
 
3:00 p.m. ADJOURN OPEN SESSION
Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×

BOX A-4
Committee on Advancing Pain
Research, Care, and Education

The National Academies Beckman Center
100 Academy
Irvine, CA 92617

AGENDA FOR PUBLIC SESSIONS
Monday, March 14, 2011

1:00 p.m. WELCOME AND INTRODUCTIONS
 
Philip A. Pizzo, M.D., Chair
 
1:05 p.m. BASIC SCIENCE OF PAIN AND APPROACHES TO PAIN TREATMENT
 
Clifford J. Woolf, M.D., Ph.D.
Professor of Neurobiology
Harvard Medical School
 
Howard L. Fields, M.D., Ph.D.
Professor, Neurology and Physiology
University of California, San Francisco
 
Frank Porreca, Ph.D.
Professor of Pharmacology and Anesthesiology
University of Arizona
 
2:20 p.m. Discussion
 
3:00 p.m. Break
 
3:15 p.m. REGULATION OF PAIN DRUGS: PERSPECTIVES FROM THE FDA
 
Bob A. Rappaport, M.D. (by phone)
Director
Division of Anesthesia and Analgesia Products
Center for Drug Evaluation and Research, FDA
 
4:00 p.m. PUBLIC COMMENTS
 
Heather Grace
American Pain Foundation/Intractable Pain Patients United
Lakewood, CA
Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×
Douglas Cook
American Pain Foundation/Intractable Pain Patients United
Lancaster, CA
 
Radene Marie Cook
American Pain Foundation
Lancaster, CA
 
5:00 p.m. ADJOURN OPEN SESSION
Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
×

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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Suggested Citation:"Appendix A: Data Sources and Methods." Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press. doi: 10.17226/13172.
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Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem.

In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, 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.

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