The National Pain Strategy: a Roadmap for Effective Care and Management of Chronic Pain in America
A roadmap for pain care and management by healthcare professionals
At this year's American Pain Society Annual Meeting, a symposium was devoted to the recently released National Pain Strategy1 (NPS), an 84 page-long document outlining a comprehensive population health approach to pain prevention, care, education and research.
As is recommended in the NPS, improvements in pain care and management require a coordinated, collaborative and inter-disciplinary approach. I believe it is critical for healthcare professionals dealing with chronic pain patients, to be cognizant of optimal practices and available resources. I will therefore devote, with this and upcoming articles, a series of features on the NPS and its implementation.
An overview of the NPS was given by one of the co-chairs of the Oversight Committee for the NIH Health and Human Services National Pain Strategy, Sean Mackey, MD, PhD. Dr Mackey is Chief of the Division of Pain Medicine and Redlich Professor of Anesthesiology, Perioperative and Pain Medicine, Neurosciences and Neurology at Stanford University. He was also a member of the Institutes of Medicine (IOM) committee which issued a report in 2011 titled “Relieving Pain in America: A Blueprint for Transforming Prevention, Treatment, and Research”, which outlined barriers to pain care, and recommendations to overcome these.2
One hundred million Americans (37% of the US adult population) suffer from chronic pain, 20 % of whom have low back pain, 16 % of whom present with neck pain and headaches. The impetus for the NPS arose from recommendation 2.2 of the IOM report, which called for the secretary of Health and Human Services to put together a National Healthcare Strategy to deal with pain prevention, pain care, pain assessment and the data related to pain. A group was put together by the Inter-Agency Pain Research Coordinating Committee3 at the NIH under the hospices of the Assistant Secretary of Health. The committee started by gathering an oversight panel roster4 with broad representation across the public and private sectors, as well as members of civil society affected by pain. In the next step, six working groups were formed, in alignment with the IOM report. Dr Mackey encouraged the audience to download the NPS report5 which he said will "transform the country's care, management and assessment of pain."
According to Mackey, the main issue with population research is the very poor quality of available pain data. The population research working group therefore proposed a set of objectives aimed at estimating the prevalence of chronic pain in the country. A new term was introduced into the NPS: ‘high impact chronic pain' to distinguish individuals self-managing their pain, from those Mackey termed ‘high utilizers', referring to patients taking a large amount of resources to help manage their pain. In order to improve national pain data quality, the working group set as an objective to standardize electronic healthcare data and develop a system metrics for traffic change over time.
The NPS committee also recognized the existence of highly vulnerable populations presenting with chronic pain, populations who are often stigmatized, and can either be under- or over-treated. They therefore set out to reduce bias and its impact on treatment, to improve access to high quality pain services across all population groups, to facilitate communication amongst patients and healthcare professionals, and to improve the quality and quantity of data to assess the impact of pain access, pain care and pain costs across the entire population group.
Another aspect the NPS addresses, is prevention care. The committee realized that many of the existing treatments were not sufficiently utilized, whereas others, although inefficient, were over-utilized. They therefore set out to perform a cross-benefit analysis in order to determine optimal treatments, to develop nationwide pain self-management programs, as well as standardized, consistent and comprehensive pain assessments and outcome measures.
In order to assure that the right behaviors were appropriately incentivized, the committee aimed to fund and evaluate integrated, multi-modal and inter-disciplinary care for people with chronic pain, and to enhance the evidence-base for pain care. Another objective consisted in integrating this scheme into clinical practices through defined incentives and reimbursement strategies, and tailor those reimbursements to promote and incentivize high-quality, coordinated pain care through an integrated psychosocial approach. The working group agreed that the future of chronic pain management lies in coordinated team-based care.
Another critical aspect of pain management and care lies in adequate education, which, according to Mackey is lagging behind. The education working group set out to develop, review, update and propagate competencies for pain care, both at the undergraduate and graduate levels, to develop a pain education portal, and disseminate knowledge and helpful skills around the area of pain to everyone caring for pain patients.
As the committee acknowledged that patients dealing with chronic pain are at the heart of this initiative, its members decided to develop and implement a national public awareness and information campaign on the impact and seriousness of chronic pain, as well as a national education campaign for safe medication use.
The six working groups are now waiting for the Department of Health and Human Services to provide additional guidance and implementation plan for this strategy. Mackey stressed the importance for all healthcare pain practiotioners to work together in order to make an impact on these strategic goals and translate them into something which will be actionable for the country.
1. The National Pain Strategy: https://iprcc.nih.gov/National_Pain_Strategy/NPS_Main.htm
2. The Institute of Medicine report: http://www.nationalacademies.org/hmd/Activities/PublicHealth/PainResearch/Pain-Care-Improvements- Recommended-in-IOM-Report.aspx
3. Inter-Agency Pain Research Coordinating Committee https://iprcc.nih.gov/
4. NPS oversight panel roster: https://iprcc.nih.gov/National_Pain_Strategy/Oversight_Panel_Members.htm
5. NPS report: https://iprcc.nih.gov/docs/drafthhsnationalpainstrategy.pdf