PAINS and the Institute of Medicine Report
Jason M. Schwalb, MD, FAANS, FACS
In 2011, at the request of the National Institutes of Health, the Institute of Medicine released its report on “Relieving Pain in America”, click here for the report. The panel that developed this report represented a broad spectrum of experts in pain, including Ken Follett, the Chair of Neurosurgery at the University of Nebraska, as well as patient advocates. This report focused on the incredible epidemiology and economic consequences of pain in the US, as well as impediments to effective pain care, including lack of education of patients and treating clinicians, legal and economic barriers and gaps in knowledge of best practices, even in the best of hands.
The principles underlying the IOM report were considered by the authors to be:
- pain management as a moral imperative,
- chronic pain as sometimes a disease in itself,
- the value of comprehensive treatment,
- the need for interdisciplinary approaches,
- the importance of prevention,
- wider use of existing knowledge,
- recognition of the conundrum of opioid use,
- collaborative roles for patients and clinicians, and
- the value of a public health- and community-based approach.
The recommendations were as follows:
- Create a comprehensive population health-level strategy for pain prevention, treatment, management, and research
- Develop strategies for reducing barriers to pain care
- Support collaboration between pain specialists and primary care clinicians, including referral to pain centers when appropriate
- Designate a lead institute at the National Institutes of Health responsible for moving pain research forward, and increase the support for and scope of the Pain Consortium
- Improve the collection and reporting of data on pain
- Promote and enable self-management of pain
- Provide educational opportunities in pain assessment and treatment in primary care
- Revise reimbursement policies to foster coordinated and evidence-based pain care
- Provide consistent and complete pain assessments
- Expand and redesign education programs to transform the understanding of pain
- Improve curriculum and education for health care professionals
- Increase the number of health professionals with advanced expertise in pain care
- Improve the process for developing new agents for pain control
- Increase support for interdisciplinary research in pain
- Increase the conduct of longitudinal research in pain
- Increase the training of pain researchers
However, the IOM can only make recommendations. It can not implement them. As a result, Myra Christopher of the Center of Practical Bioethics in Kansas City, one of the members of the IOM panel, has led the development of the Pain Action Alliance to Implement a National Strategy (PAINS), bringing together clinicians, researchers, patient advocates and industry in an effort to implement the IOM report. From the Pain Section, both Bill Rosenberg and I have been involved.
Whether we perform lumbar decompressions, microvascular decompressions or neuromodulation procedures, we can all support this effort as neurosurgical pain specialists. In addition to developing new treatments, it is all about getting the right patient the right care at the right time. Who among us has not been frustrated with the medical system after seeing a patient with straightforward neurogenic claudication that will respond to a lumbar decompression who has been conservatively managed for years with medications and injections? Who among us has not felt horrible for the patient with classic trigeminal neuralgia who has undergone multiple tooth extractions and medication trials, but not been tried on carbamazepine? With N2QOD, organized neurosurgery has taken an active role in improving the collection and reporting of data on surgery for spinal pain on a national basis. . Given our role as a specialty in treating pain, it is important for us to have a seat at the table to advocate for effective, multidisciplinary treatment.