Friday, November 6, 2009

Mayday Panel Report Urges Revolution in Pain Care

Warning that patients should not assume their doctors have enough knowledge to treat their pain, a national panel of experts called for better education on pain care in medical and nursing schools, reforms of America’s reimbursement system, and addressing pain as a public health crisis. Otherwise, people with untreated pain may face a lifetime of pain as a chronic illness, leading to job loss, depression and, in some cases, even suicide.

The report — released November 4, 2009 by the New York City-based Mayday Fund — is titled “A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform” [access report here]. It says that an “epidemic” of undertreatment affects more than 70 million Americans suffering from persistent back pain, headaches, and joint pain, and that minorities and low income persons are disproportionately affected. In addition to calling for medical school reforms and expanded funding for pain management training programs, the 22-member report panel offers recommendations for government agencies, Congress, and the medical community to address, including:
  • Healthcare providers, insurers and government agencies should eliminate disparities in access to pain care related to race, gender, age and socioeconomic status. All Americans in pain, including low-income Americans, should be offered timely and effective treatment for their pain.

  • The Department of Health and Human Services should reform payment to eliminate the current incentives that drive pain care toward procedures or unproven treatments. Primary care doctors should be reimbursed for the time it takes to provide comprehensive pain care to patients who are disabled by chronic pain.

  • The Surgeon General should mount an education campaign to inform the public about the risks associated with undertreated pain. Consumers should understand that if they wait too long to treat acute pain they run the risk of developing a chronic syndrome, one that is costly to treat and potentially disabling.

  • Government, healthcare payors, and providers should develop coordinated health information technology (IT) systems to track pain disorders and treatments. Computerized IT systems can boost physicians’ knowledge about effective treatments for pain by providing them with best practice information quickly.
Additionally, the panel recommends that the National Institutes of Health should increase funding for pain research to a level commensurate with the scope of the problem. Incredibly, less than 1% of the NIH budget in 2008 was devoted to pain. Along with that, more research is needed to establish a set of best practices for treating specific types of chronic pain. And, there is a need for federal, state, and local agencies to adopt a balanced approach to the regulation of controlled prescription drugs, particularly opioid analgesics; practitioners’ prescribing decisions should not be inappropriately influenced by fear of regulatory scrutiny.

According to Lonnie Zeltzer, MD, co-chair of the panel, and director of the Pediatric Pain Program at the University of California, Los Angeles, otherwise compassionate and skilled physicians “often offer only limited treatments to patients disabled by chronic pain. With little or no specific training in pain management, and working in systems that make it much easier to treat common conditions like high blood pressure than a complex problem like pain, doctors may intend to help but leave most patients under-assessed and undertreated.”

Chronic pain costs the nation more than $100 billion a year in lost productivity and direct medical costs, the report says. “This is a wasteful system,” observes Russell K. Portenoy, MD, panel co-chair and chairman of Pain Medicine and Palliative Care at the Beth Israel Medical Center in New York, “major reforms in the healthcare system are needed if we want to improve the quality and cost effectiveness of care for chronic illnesses, and pain is as much a chronic illness as diabetes and heart disease.”

Commentary: The report and recommendations have been endorsed by more than 30 organizations, including Pain Treatment Topics. However, this is not the first document to make recommendations such as these, which seem like a “no-brainer” in terms of their commonsense necessity and urgency. Yet, as the panel observes, even though the impact of pain on individuals and American society is among the most serious of public health concerns, chronic pain has been largely left out of the current national debate on healthcare reform. One would think that members of Congress, themselves, as well as their families, are not immune to pain disorders, so they would be clamoring to institute the recommendations of reports like this. At the least, Congress should realize that the 70 million pain sufferers in America, along with their loved ones, represent an enormously powerful voting block that could some day rise up to demand the pain care revolution promulgated in this report — even if it means replacing congressional representatives who do not vigorously support such measures.