Workers' Compensation

Reforming Chronic Pain Treatment: New Attitudes and Better Knowledge Advocated

The 2010 Patient Protection and Affordable Care Act, a.k.a. Obamacare authorized the Institute of Medicine (IOM) to study issues related to chronic pain. One reason for this effort was that chronic pain issues annually cost the workers’ compensation system and society as a whole an estimated $635 billion in treatments and lost productivity.

Overview of IOM Research

The IOM’s research extended beyond studying misuses of prescription pain medications; this work also addressed how patients with chronic pain and the health care providers who treated that discomfort handled related issues that included general perceptions about that type of suffering and the best methods for alleviating it.

These findings and recommendations were published in a 329-page report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Our discussion below focuses on its recommendations.

Other Primary Chronic Pain Issues

The IOM report explicitly stated that its findings and recommendations revolved around the “single conclusion” that pain affecting more than 100 million Americans makes controlling it enormously valuable “to individuals and society.”

This statement declared next that reducing pain’s impact and its related suffering required changing the perception of pain by people who experienced it and health care providers who treated them. The report identified “the overarching goal of this transformation” as “gaining a better understanding of pain of all types and improving efforts to prevent, assess, and treat pain.”

An introductory passage in the report stated regarding the underlying characteristics and ills of chronic pain that pain can “contribute to severe and even relentless suffering” and can “become a disease in its own domains and dimensions.”

This text stated as well that “we all may share common accountings of pain, but in reality, our experiences with pain are deeply personal, filtered through the lens of our unique biology, the society and community in which we were born and live, the personalities and styles of coping we have developed, and the manner in which our life journey has been enjoined with health and disease.”

The IOM report acknowledged further that “pain can often be controlled” but “frequently cannot be eliminated.” The report added that non-eliminated pain “becomes more dominant for the individual than her or his underlying disease.”

Another concern was that pain that “could not be seen or measured ‘objectively’ or interpreted within the context of the unknown” “was more likely to be dismissed, diminished, or avoided.”

The report’s recommendations reflected an “it takes a village” approach to managing chronic pain. The overall theme was that controlling pain and the disease that often accompanied it “depends on the ability of individuals to garner information and assistance, of family members to give productive help, of clinicians to explore many options, and of communities to create systems to support families and clinicians.”

The conclusions related to health care professionals were the most relevant to the workers’ compensation community. Specific problems included “many health care providers lack[ing] a comprehensive perspective on pain and not infrequently interpret[ing] the suffering of others through their own personal lens.” A related concern was that the psychological and cognitive impacts of chronic pain often go untreated.

Public Health Challenge

The IOM stated regarding the overall public health challenge related to chronic pain that “substantial disparities exist in the prevalence, seriousness, and adequate treatment of pain that affect the vulnerable populations of traditional health concerns.” These populations include lower-income people and rural communities.

The report added that “pain exacts enormous costs both economically and in the toll it takes on people’s lives.”

One specific deficiency that the IOM identified regarding addressing these problems included currently available state and national data not allowing monitoring changes “in the incidence and prevalence of acute and chronic pain.”

Other information that the report recommended collecting was data on treating or undertreating pain, “the health and societal consequences of pain,” and the effect of relevant “changes in public policy, payment, and care.”

Caring for Chronic Pain Patients

The IOM also concluded that “large numbers of Americans receive inadequate pain prevention, assessment, and treatment.” The report partially attributed this to “financial incentives that work against the provision of the best, most individualized care; unrealistic patient expectations, and a lack of a valid and objective pain assessment measures.”

A related conclusion was that “primary care is organized in ways that rarely allow clinicians time to perform comprehensive patient assessments.”

The report recommended that pain care “be tailored to each person’s experience.” It stated specifically that “health care providers need to foster pain care that is patient-centered and, when necessary, comprehensive and interdisciplinary.”

Chronic Pain Education Challenges

Another section of the report identified shortfalls regarding education related to treating chronic pain. These conclusions included that a typical medical education has not included much instruction on that subject.

The IOM stressed that “enhanced continued education and training are needed for health care professionals to address gaps in knowledge and competencies related to pain assessment and management, cultural attitudes about pain, negative and ill-informed attitudes about people with pain, and stereotyping and biases that contribute to disparities in pain care.”

Education-based recommendations for patients focused on self-management of chronic pain. The goals of this effort included minimizing flare-ups of pain, decreasing everyday discomfort, and maximizing the patient’s ability to function.

Chronic Pain Research Challenges

Recommendations regarding research that was directed at improving chronic pain treatments included using current knowledge of “basic biological and psychological underpinnings of pain” “to develop innovative therapies that are simultaneously more targeted to the individual and more comprehensive in meeting patient needs.”

No Pain, Tremendous Gain

The IOM showed how improving the means for treating chronic pain will decrease the treatment costs and lost productivity. They also demonstrated that this will require coordinated efforts of the “village” consisting of claimants, insurers, health care providers, and government agencies.

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