Pain is now considered a disease, not a condition.
Government agencies, led by the Department of Health and Human Services, are collaborating on a National Pain Strategyopens in new window to coordinate government and private efforts toward establishing a biopsychosocial model of pain care.
The basis for the new pain strategy came from an Institute of Medicine 2011 reportopens in new window, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research." It recommends that health-care providers treat chronic pain like a disease, not a condition, a "cultural transformation" that can prompt big changes in all aspects of diagnosis and treatment.
"People with chronic pain often are not taken seriously even though their pain and suffering may dominate their lives," says project coordinator Linda Porter, PhD, policy advisor for pain at the National Institute of Neurological Disorders and Stroke.
Such patients may be dismissed by health-care providers, especially when the cause of the pain is not clear, or because of bias, inadequate education, or lack of understanding of the consequences of pain on a patient's life, she says. It's critical, she says, to recognize chronic pain as a disease with underlying biopsychosocial mechanisms and to create a health-care environment "in which it is culturally accepted as real and not to be dismissed."
It also means looking at pain as a pathological condition that affects multiple aspects of a person's health and that should be considered by every aspect of health care, from research to patient evaluation and treatment and provider training and reimbursement. The strategy recommends more attention to pain's emotional, cognitive and behavioral components. It calls for thorough assessments of who might develop chronic pain, care plans that address its potential psychological and social effects, and self-management programs distributed nationwide to help people cope with pain — all of which suggest a much greater involvement from psychologists.
"The strategy, if implemented, will have far-reaching effects on the integration of behavioral health across all levels of care," says Beverly Thorn, PhD, professor and chair of the department of psychology at the University of Alabama, a member of the working group that helped develop the strategy. "Pain is not just a problem in specialty clinics — it is a problem across the care spectrum. Appropriately trained psychologists will provide a strong presence to implement evidence-based behavioral treatment for pain management."
A strategic priority is providing sustainable, appropriately adapted pain management care to groups with multiple disparities, who are now getting the least care but are likely to need it most, Thorn says. Another critical component is pain education for clinicians — including clinical health psychologists — who many experts say need more training in comprehensive pain treatment and in chronic pain prevention. It also promotes a national education campaign encouraging safe use of medications, especially opioids.
A task force of 80 experts from government, nonprofits, academia and private companies developed the plan, and at press time were redrafting the strategy following public comments on it. When the strategy goes forward, first steps on chronic pain prevention and treatment include looking at benefit-to-cost ratios for preventing injuries and for existing pain treatments.
For more information, see National Pain Strategyopens in new window.
— Stacy Lu
