The “Decade of Pain Control and Research": Part I
Part I: What Have Been the Greatest Achievements in the Past Ten Years?
In the year 2000, the Joint Commission on Accreditation of Healthcare Organizations released new standards for the assessment and management of pain in the facilities they accredit and certify. C. Richard Chapman, Ph.D., then the President of the American Pain Society, described this as “a giant step…a major leap forward”. A few months later Congress passed and the President signed a law that declared the ten-years beginning January 1, 2001 as the Decade of Pain Control and Research.
Kathryn L. Hahn, Pharm.D.:
Kathryn L. Hahn, Pharm.D. is Affiliate Faculty, Oregon State University College of Pharmacy, Chair, Oregon Pain Management Commission, American Pain Foundation State Action Leader, and Pharmacy Manager, Bi-Mart Corp. She also serves on the Board of Directors of the Academy of Pain Management.
"What is your personal evaluation of the achievements in the past ten years as the Decade of Pain Control and Research draws to an end?"
Over the past decade a great deal has been accomplished. Health care providers now know that chronic pain is a disease state that can be treated, and that it is “epidemic” in occurrence. Ten years ago we taught that opioids should be available as needed for patients with cancer pain, but not necessarily if you were living with non-malignant chronic pain. Now we have learned through published evidence-based practice guidelines from the American Pain Society, that cancer pain and chronic pain can both be treated with opioids. We have also learned that there are other non-opioid medications that have shown good results in clinical studies of many pain diagnoses. Excellent comprehensive guidelines now exist for difficult diagnoses such as fibromyalgia and neuropathic pain, including non-opioid and non-pharmacologic recommendations. Expert approved websites offering information, education, and tools for providers and patients are plentiful now, and seem to be having an impact.
Even though we have made progress, we still have a lot more questions to answer. For example, we know how to effectively treat chronic pain due to failed back treatment, but we don’t necessarily know what will happen to this patient over the next ten, twenty, or thirty years. There has been a pitifully small amount of research done with patients who are receiving long-term treatment. Are we helping them or hurting them with pain medications? Should we encourage more use of Complementary and Alternative Medicine methods instead?
I also think that at the end of this decade, in spite of all of the progress that has been made, we may have actually taken a step backward for chronic pain patients, as we deal with the suggestion of limiting access to pain medications in the future. The “War on Drugs” and provider concerns about prescription pain medication abuse, misuse, and diversion, as well as provider liability and lack of adequate health insurance reimbursement, may have made it more difficult to find a clinician who is willing to assume the medical care for a chronic pain patient, especially if an opioid medication is the treatment of choice.
The concern about misuse of pharmaceuticals which has soared over the last three to four years has stopped us in our tracks; taking away from what we had achieved by having pain recognized as the fifth vital sign, and understanding that pain is as the patient describes it. Now all of the focus seems to be on risk mitigation and the conversation has changed. I am a spokesperson for several pain safety initiatives so I know that while pain treatment is important, we also have to protect the patient, family, and the community.
If the FDA’s Risk Evaluation and Mitigation Strategies for opioids (REMS) are done correctly, they can give a great boost to our attempts to provide educational opportunities for both patients and providers. But I believe that education is not enough. We need to increase utilization of tools such as the state prescription monitoring programs, and continue to implement risk reduction strategies such as universal precautions. If the part of REMS that limits access is draconian, we will need to tread very carefully to ensure proper balance between public safety and appropriate pain care access.