Relieving Pain in America A Blueprint for Transforming Prevention, Care, Education, and Research (2011) / Chapter Skim
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Pages 349-364
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From page 349... ...
, 193, 200, 210 alternative medicine (CAM) services Acetaminophen, 130 Alzheimer's Association, 189 Activities of daily living, effects of pain on, Alzheimer's disease, campaigns to educate 86, 139 about, 188–189 Acupuncture, 135–136, 208 Alzheimer's Disease Education and Referral Acute pain, 1, 32–33, 277 Center, 189 better treatment for, 100 American Academy of Family Physicians, 197 choice of a treatment approach for, 124, 126 American Academy of Neurology, 199, 249 common sources of, 29 American Academy of Orofacial Pain, 120 Addiction, 36, 277 American Academy of Orthopedic Surgeons, Adequacy of pain control, in hospitals and 303 nursing homes, 140–141 American Academy of Pain Management, 120 Adherence to drug regimen, problems with, 131 American Academy of Pain Medicine, 120, 123 Adjusting to pain.
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From page 350... ...
, 185–186 American Productivity Audit telephone survey, Barriers to effective pain care, 8–9, 152–157 86 cultural attitudes of patients, 156–157 American Psychological Association (APA) , geographic barriers, 157 205–206 insurance coverage, 156 Committee on Accreditation, 210 magnitude of the problem, 9, 153 American Recovery and Reinvestment Act, provider attitudes and training, 153–156 245 regulatory barriers, 157 American Society for Pain Management written public testimony on, 294 Nursing, 120, 203 Barriers to improving pain care American Society of Interventional Pain clinician-level barriers, 45–46 Physicians, 120 overview of, 45–47
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From page 351... ...
See Education challenges; Center, 161 Research challenges British Pain Society, 219 Children Bureau of Health Professions, 210 causes and persistence of pain in, 37 Bureau of Labor Statistics, 80 disparities in prevalence and care for, 77–78, 192 Chiropractic spinal manipulation, 135, 208 C Choice of a treatment approach, 124–127 environmental factors affecting, 125 Canada, public education campaign on low individual-related factors affecting, 125 back pain, 186 pain-related factors affecting, 125 Cancer patients, 314 Chronic fatigue syndrome, 75 disparities in prevalence and care for, 84 Chronic pain, 1, 32–33, 278, 295 fear in, 43 choice of a treatment approach for, Cardiovascular patients, 131 126–127 Care of people with pain, 113–177. See also common sources of, 29 Barriers to improving pain care complexity of, 34–36, 300 barriers to effective pain care, 153–157 as a disease in itself, 4, 26 blueprint for transforming, 14–17, 269–275
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From page 352... ...
, Medical Care Clinical pharmacy specialist, 129 inflation index of, 302 Clinical Trials Transformation Initiative, 231 Control variables, in the economic costs of Clinician-level barriers, to improved pain care, pain, 306–307 45–46 Cost models for selected pain conditions Clinicians, roles for, 3, 22 incremental, 316–317 CME credit, 193, 195–196 indirect, 323–324 Cognitive-behavioral therapy, 43, 132, 207, Costs of pain and its treatment, 91–95. See 226, 278 also Direct costs; Economic costs Cognitive context, of the causes and of pain; Emotional cost of pain; persistence of pain, 42–44 Incremental costs; Indirect costs Cognitive impairments, disparities in to families, 94–95 prevalence and care for people with, to the nation, 56, 91–93 82–83 opioid use and, 147–148 Collaboration, need to support, 9, 163–164 and savings from a public health approach, Collins, Francis S., 240 100 Commission on Accreditation of Rehabilitation Counseling, 4 Facilities, 123 Cowan, Penny, 34 Commissioned paper, 283, 301–337 Cowley, Terrie, 184, 217, 224 Committee on Accreditation (of the APA)
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From page 353... ...
, 2, 7, 20, 56, 102 discussion, 313–314 Department of Veterans Affairs, 5, 13, estimation strategy, 307–309 56, 80–82, 93, 114, 122, 206, 246, Education 253 competency-based, 197 Centers of Excellence in Primary Care Internet-based, 197 Education, 203 potential savings from improvements in, model of pain care, 158–160 100 Pain Research Program, 242 Education challenges, 10, 179–216 Dependent variables, for the economic costs of about opioid analgesic use, need for, pain, 305–306 145–146 Depression, xi, 4, 41, 70, 88, 118 blueprint for transforming, 10–11, 14–17, Descartes, René, 34 269–275 Diagnosing pain. See Pain diagnoses in complementary and alternative medicine Direct costs (CAM)
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From page 354... ...
See Pain care Exercise, in pain management, 133–134 Gaskin, Darrell J., 301–337 Existing knowledge, wider use of, 3, 22 Gender Expenditure models, total, for selected pain differences in the seriousness of pain by, conditions, 319–320 89–90 Expenditures, for selected pain conditions, disparities in prevalence and care by, 318 75–77 Experiences providing pain treatment, written Generalized linear model, hourly wages public testimony on, 294 models for selected pain conditions, 332–333
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From page 355... ...
See also Pain as a public health Imaging, to investigate pain, 38–39 challenge Immediate goals, for transforming pain impact of pain on physical and mental, prevention, care, education, and 31–32 research, 270, 272–273 influence of occupational rank on, 74 Impact of pain, written public testimony on, Health and Retirement Study, 68, 72 295 Health care expenditure models, estimation Improving pain care, written public testimony strategy for, 307–308 on, 294 Health disparities, 265–266 Income, disparities in prevalence and care by, Health literacy, 66 73–75 low rates of, 66 Incremental cost models, for selected pain Health Psychology Network, 205 conditions, dependent and independent Health Resources and Services Administration, variables used in, 316–317 11, 210 Incremental costs Healthcare Effectiveness Data and Information of health care, 308–311 Set (HEDIS) , 149–150 of medical expenditures, by source of Healthy People 2020, 57–58 payment, 322 Pain Relief Objectives, 58 of medical expenditures for selected pain Heart surgery, complications following, 84 conditions, 321 Heckman selection models, 309 of number of days of work missed because Helplessness, about pain, 88 of selected pain conditions, 334 Herman, Gwenn, 180 of number of hours of work missed Hip replacement surgeries, 132 because of selected pain conditions, Hispanics 335 disparities in prevalence and care for, Independent factors, in the economic costs of 70–71, 310 pain, 305 language problems for, 65–66 Indian Health Service (IHS)
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From page 356... ...
, 25, 47, 120, 205, 219, 239 Limitations on data, 59–61 International Covenant on Economic, Social, Listening skills, of physicians, 193–194 and Cultural Rights, 143 Literature review, 201, 282 Internet, education based on, 197, 252 Logistic regression, hourly wages models for Interstitial cystitis, 75, 137 selected pain conditions, 332–333 InterTribal Council of Arizona, Inc., 72 Longitudinal research, need for, 13, 60–61, Interviews. See Structured psychiatric 253 interview methods Low back pain Ion channels, 222 chronic, 63–64 Iraq conflicts, 81, 157–158 fiscal challenge of caring for, 148 Issues in pain care practice, 137–152 public education campaigns on, 97, access to opioid analgesics and concerns 185–186 about their use, 142–148 adequacy of pain control in hospitals and nursing homes, 140–141 M difficulties in measuring pain, 137–140 insurance incentives, 148–150 Magnitude of the problem, of effective pain pain and suffering at the end of life, care, 153 141–142 Management of pain.
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From page 357... ...
See also Hourly wages models of pain, 262 models; Missed days models; Missed molecular and cellular mechanisms of hours models pain, 259–260 Models of pain care, 158–161. See also pain management, 263–264 Cost models for selected pain research objectives, 259 conditions; Health care expenditure translational pain research, 266–267 models; Indirect cost models; Quality Mechanisms of pain, molecular and cellular, improvement (QI)
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From page 358... ...
, 12, 20, 56, Nurse Practitioner Healthcare Foundation, 92, 99, 189, 218–219, 245, 253, 313 201 Common Fund, 241 Nurses, 91, 201 National Center for Complementary and education of, 201–204 Alternative Medicine, 134 Nursing homes, adequacy of pain control in, Pain Consortium, 7, 11–12, 103, 190, 240, 69, 142 242–244, 251–252, 269–270 Roadmap for Medical Research, 237, 241 O National Institutes of Health Reform Act, 240 National Nursing Home Survey (NNHS) , 82 Obesity, and pain, 63, 226 National Pain Management Strategy, 158 Objectives National Research Council, 303 regarding the economic costs of pain, 302 National Violent Death Reporting System of research, 259 (NVDRS)
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From page 359... ...
See also Acute pain; Barriers to Pain diagnoses, 262–263 improving pain care; Chronic pain; total direct costs of medical care for, Economic costs of pain; Joint pain; 312–313 Low back pain; Musculoskeletal pain; uncertainty of, 4, 46 Neuropathic pain; Orofacial pain; Pain diaries, 238 Prevalence of pain; Referred pain; Pain Genetics Lab, 36 Seriousness of pain; Translational pain Pain in childhood, causes and persistence of, in animals, 223 37 causes and persistence of, 34–44 Pain management, xi, 263–264. See also Self complexity of, 8, 24–26, 220 management of pain definitions of, 1, 24–26, 278 Pain Management Directive, 158 impact on physical and mental health, Pain management index, 68 31–32 Pain prevention, 95–98, 233 maladaptive coping strategies, 94 blueprint for transforming, 14–17, 269–275 the picture of, and risk, 27 examples of population-based initiatives, protection from and relief of, ix 97 romanticizing, ix importance of, 3–4, 22, 45 statistics on, 28 potential savings from improvements in, typology of, 32–34 100 universality of, 2, 19, 55–56 role of public health in, 95–98 as a warning, 24 "Pain pumps," 131 Pain adjustment, assessment of states related Pain-related disability, 29, 117 to, 237–238 among adults with pain, extent of, 86 Pain and Palliative Medicine Specialty Section Pain Relief Ladder, 143 Council (of the AMA)
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From page 360... ...
See also Electronic cognitive context, 42–44 prescription monitoring system the complexity of chronic pain, 34–36 getting filled, 157 emotional context, 40–42 of opioids, written public testimony on genetic influences, 36–37 difficulties surrounding, 297–298 nerve pathways, 38 President's Commission on Care for America's pain in childhood, 37 Returning Wounded Warriors, 81 Pharmacist, 129 Prevalence of pain, 9, 61–64 Pharmacokinetic data, 233 key shortcomings of data on, 60 Phenotyping, 223 rising, 5 Physical and occupational therapy trends in the United States, 64 education in, 207–208 Prevention of pain. See Pain prevention not covered by insurance, 296 Primary care physicians, 9, 116–117 rehabilitative, 133–134 education challenges of, 154–155, 163, Physical conditioning programs, 133 196–198 Physical health, impact of pain on, 31–32 first step for many patients, 8, 116, 150 Physician-patient communication, 68, 126, protocols to guide, 155–156 137, 152 shortage of, 148, 197
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From page 361... ...
model, 160, 196 potential, 248–250 Quality of life, effects of pain on, xi, 87–88, Provider attitudes and training, a barrier to 139 effective pain care, 153–156 Quotations from pain sufferers, 19, 24, 26, 32, Psychiatric disorders, 265 59, 85, 113, 142, 158, 179, 190, 238, Psychological stressors, 37 293–300 as factors in pain, 25 Psychological therapies, for treating people with pain, 114, 132–133, 227 R Psychological traits, assessment of, 237–238 Psychology, education in, 204–206 Racial and ethnic factors, 66–73, 89–90 Psychosocial approaches African American, 67–70 assessment of dimensions of pain, 236–237 American Indians and Alaska Natives, assessment of psychological traits and 72–73 states related to pain adjustment, Asian Americans, 71–72 237–238 Hispanics, 70–71 ongoing assessment and monitoring of pain Randomized controlled trials (RCTs) , and pain-related states, 238 228–230 opportunities in, 127, 133, 223 failures of, 229–230 research in, 220, 236–238 Recommendations and findings, 4–13, 100 shortfalls in applying in practice, audiences for, 23, 57 226–227 Reengineering the Clinical Research PsycINFO, 282 Enterprise, 241 Public education, 184–190 Referred pain, 35, 279 Public education campaigns on low back pain, Registries, 234–236 185–186 Regulatory barriers, to effective pain care, 157 Australia, 97, 185–186 "Regulatory science," defined, 224 Canada, 186 Regulatory Science Initiative, 224 Norway, 186 Rehabilitation Institute of Washington, 161 Scotland, 186 Rehabilitative therapy, for treating people with Public health-based approach.
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From page 362... ...
, 240 need for longitudinal, 13 Scope of the problem of pain, 59–64 obtaining federal research funding, data sources and limitations, 59–61 244–245 overall prevalence, 61–64 organizational alternatives, 241–243 Scotland, public education campaign on low organizing research efforts, 239–243 back pain, 186 pain management, 263–264 Self-care, facilitation of, 4 research objectives, 259 Self-efficacy, 44, 279 a road not taken, 239–241 Self-management of pain, 8, 44, 114, 116–117 translational pain research, 266–267 promoting and enabling, 162, 227 Research methods Self-reporting of pain, 236 comparative effectiveness research, Sensitivity, declining in the elderly, 79 observational studies, and Sensitization, 33, 36, 279 psychological research, 232–234 Seriousness of pain, 85–90 improving and diversifying, 228–238 differences in the seriousness of pain by initiatives to address limitations of clinical race/ethnicity and sex, 89–90 trials, 230–232 effects on activities of daily living, 86 observational studies, databases, and effects on productivity, 86–87 registries, 234–236 effects on quality of life, 87–88 psychosocial research, 236–238 effects on the risk of suicide, 88–89 randomized controlled trials: the gold Serotonin, 40 standard, 229–230 Sex Research results, 303, 309–313 differences in the seriousness of pain by, incremental costs of health care, 309–311 89–90 indirect costs of health care, 311–312 disparities in prevalence and care by, total direct cost for medical care for pain 75–77 diagnoses, 312–313 Shingles, 79 Research Teams of the Future, 241 Shoulder replacement surgeries, 132 Research workforce Sickle-cell disease, pain associated with, 122, building, 238–239 295 increasing training of, 13
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From page 363... ...
See Undertreated groups Treatment modalities for pain, 129–137 Subjectivity, of the experience of pain, 25, 223 choice of a treatment approach, 124–127 Substance Abuse and Mental Health Services complementary and alternative medicine, Administration (SAMHSA) , 99, 134–136 145–146 measuring effectiveness of, 192, 227 Substance P antagonists, 300 medications, 129–131 Suffering, protection from and relief of, ix note on the use of placebos, 136–137 Suicide, effects of pain on the risk of, 88–89 overview, 115 Surgeon General, Office of, 56, 189 psychological therapies, 132–133 Surgery, for treating people with pain, 68, 114, regional anesthetic interventions, 131 131–132 rehabilitative/physical therapy, 133–134 Surgical patients, 63 steps in care, 115–124 disparities in prevalence and care for, surgery, 131–132 83–84 written public testimony on the need for Survey overview, 294 new, 300 System-level barriers, to improved pain care, TRICARE, 5, 93 45 Truman, Harry S, 269 Tufts University School of Medicine, 208 Typology of pain, 32–34 T Teams, using interdisciplinary approaches, U 121–124 Telephone survey, American Productivity U.K.
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From page 364... ...
, 199 Pain Relief Ladder, 143 University of New Mexico Project ECHO Pain World War II, 82 Clinic, 161 WorldCat, 282 Unknown causes of pain, 34 Written public testimony, 293–300 Urban Indian Health Program (UIHP) , 72 conclusion, 300 U.S.
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