Feature

If the recommendations of a new Institute of Medicine report get implemented, the way clinicians, researchers and patients approach pain management will place more emphasis on the psychological and social aspects of pain, says psychologist Francis Keefe, PhD, who sat on the committee that wrote the report.

That shift from a biological model of pain — where pain is considered a sensory response to a specific injury — to a more integrated model that includes biological, psychological and social factors should spur a move toward team-centered pain management that includes primary-care physicians, nurses, physical rehabilitation specialists, and psychologists and other mental health professionals, says Keefe, professor of medical psychology and professor of psychology and neuroscience at Duke University.

The report, released in June and titled "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research," emphasizes the need to treat pain as an independent disease, at least in some cases, not simply a byproduct of another disease or injury. In fact, says the report, pain is one of the biggest public health problems in the United States, with an estimated 116 million Americans living with pain — more than those affected by heart disease, diabetes and cancer combined. Acute and chronic pain costs the country an estimated $635 billion each year in medical treatment and lost productivity.

The hope is that the findings regarding biopsychosocial aspects of pain highlighted in the report will trickle down to primary-care settings where people typically seek help for pain, says Keefe. It is becoming clear that primary-care physicians need to better understand the psychological and social underpinnings of both acute and chronic pain and that psychologists need to better understand how to integrate psychological models of pain with pharmacological and surgical interventions.

APA's Education Directorate, in conjunction with APA's Div. 38 (Health), has been working for years to develop educational competencies for training programs that prepare psychologists to work in primary care and health-care settings, including training in pain management, says Cynthia Belar, PhD, APA's executive director of education.

In addition, APA has advocated for insurance reimbursement policies that support team-based approaches to care — a specific recommendation made in the IOM report.

Overall, "the report fits nicely within APA's strategic plan, which focuses on the need for better integrated care," she says.

Among the report's calls for action are:

  • Creating a comprehensive strategy for pain prevention, treatment, management and research.

  • Supporting collaborations between pain specialists and primary-care physicians.

  • Designating a lead institute at NIH responsible for moving pain research forward.

  • Expanding and redesigning education programs to transform the understanding of pain.

  • Increasing support for interdisciplinary research in pain.

  • Increasing the training of pain researchers.

The report speaks to more than 30 years of efforts to reshape how people think about pain, says psychologist and IOM committee member Robert Kerns, PhD, national program director for pain management of the Department of Veterans Affairs and professor of psychiatry, neurology and psychology at Yale University. This report represents a turning point in that thinking, he says.

"Over-reliance on a purely biological perspective on pain often contributes to an enormous amount of suffering and increased cost," adds Keefe. "This report holds out the hope that by using a broader, biopsychosocial approach to pain, much of that suffering and cost can be prevented."


Beth Azar is a writer in Portland, Ore.