IOM Report on Pain Ignores Rheumatologists

Rheumatologists are on the front lines of pain management, yet they were not consulted by the Institute of Medicine committee that wrote a comprehensive new report on pain.

An estimated 25 million Americans have osteoarthritis and 1.7 million have rheumatoid arthritis, according to the National Institute of Arthritis and Musculoskeletal Diseases. Arguably, these figures place rheumatologists at the eye of the nation’s pain storm.

The report "ignores the fact that there are different types of pain specialists. When they talk about a pain specialist, they are talking about an anesthesia-oriented pain specialist, not those who deal with pain as a specialty, like rheumatology or neurology," Dr. Roy Altman said in an interview. "Because this report was [written by] a predominance of anesthesiologists, a couple of pediatric people, one neurologist, plus a lot of epidemiologists, it doesn’t really approach the people on the front line who are dealing with the pain."

The author specialties are more procedure-oriented toward pain, Dr. Altman said, versus the more nonpharmacologic and pharmacologic approaches taken by internists, other primary care physicians, and rheumatologists.

A greater awareness of pain and its adverse health consequences, improved patient education and self management, and an increased emphasis on prevention are major strategies in a comprehensive new report on pain from the Institute of Medicine (IOM).

Health care providers are among those the report authors task with fostering a transition to better pain management in the United States. "Among steps to improving care, health care providers should increasingly aim at tailoring pain care to each person’s experience, and self management of pain should be promoted. Also, primary care physicians – who handle most front-line pain care – should collaborate with pain specialists in cases where pain persists," according to a brief of the report.

This collaboration is "critical," Dr. Nancy E. Lane said in an interview. "Patients with chronic pain seek out a number of different physicians, the care is not coordinated, and the patients can suffer." Dr. Lane is professor of medicine and rheumatology at the University of California, Davis and director of the UC Davis Center for Healthy Aging.

As part of the 2010 Patient Prevention and Affordable Care Act, the U.S. Department of Health and Human Services charged the IOM with assessment of the state of pain in the United States from a public health perspective. The 19 committee members also prioritized strategies for improvements in the "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" report, released in June.

"There is one major problem with the report, and that is the selection of people [who] wrote it. There are no primary care physicians and there are no rheumatologists involved," Dr. Altman, professor emeritus of rheumatology at the University of California, Los Angeles, said in an interview. "In other words, it excludes a lot of the people who treat pain."

The report "won’t change anything in my specialty," Dr. Altman said. "Rheumatologists, as a group, have already titled ourselves as the specialists for pain for the rheumatic diseases.

Dr. Lane was a bit more positive about the impact of the report. "It reminds me to always be vigilant about taking a thorough pain history and talking to my patients about their pain, how they are managing it, and filling in the gaps."

The committee estimated that 116 million Americans experience chronic pain. They state the cost of medical treatment and lost productivity associated with pain in the United States is an estimated $635 billion each year. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy, the authors stated.

Strategies include:

• A heightened awareness of pain and its health consequences.

• An emphasis on the prevention of pain.

• Improved pain assessment and management within federal health care and financial programs.

• Patient education on management of their own pain through public health communication strategies.

• Decreasing disparities in the pain experience among subgroups of Americans.

The emphasis on patient self-management of pain also is critical, Dr. Lane said. "Education on pain and how to treat it will empower the patients, just as the arthritis self-help classes have done for years. They improve self efficacy."

"You cannot control pain if the patient does not deal with it," Dr. Altman agreed. "If a patient doesn’t have an investment and take control of their pain, they are not going to get better."

"Fibromyalgia is so prominent throughout the country," he added, "that to think about not having the patient invested in their pain control is really an exercise in futility."

Improvement of pain management and prevention efforts among underdiagnosed and/or undertreated subpopulations is another tenet of the report. Those at risk include surgery and cancer patients; people at the end of life; racial and ethnic minorities; people with lower income and education levels; women, children, and older people; and military veterans. This need is not unique to pain, Dr. Altman said. "That same disparity exists in all medical care. People who are at risk for not having pain control are the people who are at risk for not getting medical care. It’s the same population."

Strategies to reduce barriers to pain care are among the recommendations that should be implemented by the end of 2012, the report committee said. Support of greater collaboration between pain specialists and primary care clinicians also should be established by the end of next year.

In addition, an existing institute within the National Institutes of Health should become the lead institute and responsible for moving pain research forward as well by the end of 2012, the report states. The NIH Pain Consortium also should take a stronger leadership role in fostering the necessary research. Dr. Altman was somewhat pessimistic about these proposals. "They make a recommendation in here that the NIH devotes some specific groups to pain control. Good luck with that in this financial climate."

Ongoing efforts to enact the remaining recommendations in the report, the authors stated, should be finalized by the end of 2015.

Dr. Lane and Dr. Altman said that they had no relevant financial disclosures.

The report is available from the IOM website.

Rheumatologists are on the front lines of pain management, yet they were not consulted by the Institute of Medicine committee that wrote a comprehensive new report on pain.

An estimated 25 million Americans have osteoarthritis and 1.7 million have rheumatoid arthritis, according to the National Institute of Arthritis and Musculoskeletal Diseases. Arguably, these figures place rheumatologists at the eye of the nation’s pain storm.

The report "ignores the fact that there are different types of pain specialists. When they talk about a pain specialist, they are talking about an anesthesia-oriented pain specialist, not those who deal with pain as a specialty, like rheumatology or neurology," Dr. Roy Altman said in an interview. "Because this report was [written by] a predominance of anesthesiologists, a couple of pediatric people, one neurologist, plus a lot of epidemiologists, it doesn’t really approach the people on the front line who are dealing with the pain."

The author specialties are more procedure-oriented toward pain, Dr. Altman said, versus the more nonpharmacologic and pharmacologic approaches taken by internists, other primary care physicians, and rheumatologists.

A greater awareness of pain and its adverse health consequences, improved patient education and self management, and an increased emphasis on prevention are major strategies in a comprehensive new report on pain from the Institute of Medicine (IOM).

Health care providers are among those the report authors task with fostering a transition to better pain management in the United States. "Among steps to improving care, health care providers should increasingly aim at tailoring pain care to each person’s experience, and self management of pain should be promoted. Also, primary care physicians – who handle most front-line pain care – should collaborate with pain specialists in cases where pain persists," according to a brief of the report.

This collaboration is "critical," Dr. Nancy E. Lane said in an interview. "Patients with chronic pain seek out a number of different physicians, the care is not coordinated, and the patients can suffer." Dr. Lane is professor of medicine and rheumatology at the University of California, Davis and director of the UC Davis Center for Healthy Aging.

As part of the 2010 Patient Prevention and Affordable Care Act, the U.S. Department of Health and Human Services charged the IOM with assessment of the state of pain in the United States from a public health perspective. The 19 committee members also prioritized strategies for improvements in the "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" report, released in June.

"There is one major problem with the report, and that is the selection of people [who] wrote it. There are no primary care physicians and there are no rheumatologists involved," Dr. Altman, professor emeritus of rheumatology at the University of California, Los Angeles, said in an interview. "In other words, it excludes a lot of the people who treat pain."

The report "won’t change anything in my specialty," Dr. Altman said. "Rheumatologists, as a group, have already titled ourselves as the specialists for pain for the rheumatic diseases.

Dr. Lane was a bit more positive about the impact of the report. "It reminds me to always be vigilant about taking a thorough pain history and talking to my patients about their pain, how they are managing it, and filling in the gaps."

The committee estimated that 116 million Americans experience chronic pain. They state the cost of medical treatment and lost productivity associated with pain in the United States is an estimated $635 billion each year. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy, the authors stated.

Strategies include:

• A heightened awareness of pain and its health consequences.

• An emphasis on the prevention of pain.

• Improved pain assessment and management within federal health care and financial programs.

• Patient education on management of their own pain through public health communication strategies.

• Decreasing disparities in the pain experience among subgroups of Americans.

The emphasis on patient self-management of pain also is critical, Dr. Lane said. "Education on pain and how to treat it will empower the patients, just as the arthritis self-help classes have done for years. They improve self efficacy."

"You cannot control pain if the patient does not deal with it," Dr. Altman agreed. "If a patient doesn’t have an investment and take control of their pain, they are not going to get better."

"Fibromyalgia is so prominent throughout the country," he added, "that to think about not having the patient invested in their pain control is really an exercise in futility."

Improvement of pain management and prevention efforts among underdiagnosed and/or undertreated subpopulations is another tenet of the report. Those at risk include surgery and cancer patients; people at the end of life; racial and ethnic minorities; people with lower income and education levels; women, children, and older people; and military veterans. This need is not unique to pain, Dr. Altman said. "That same disparity exists in all medical care. People who are at risk for not having pain control are the people who are at risk for not getting medical care. It’s the same population."

Strategies to reduce barriers to pain care are among the recommendations that should be implemented by the end of 2012, the report committee said. Support of greater collaboration between pain specialists and primary care clinicians also should be established by the end of next year.

In addition, an existing institute within the National Institutes of Health should become the lead institute and responsible for moving pain research forward as well by the end of 2012, the report states. The NIH Pain Consortium also should take a stronger leadership role in fostering the necessary research. Dr. Altman was somewhat pessimistic about these proposals. "They make a recommendation in here that the NIH devotes some specific groups to pain control. Good luck with that in this financial climate."

Ongoing efforts to enact the remaining recommendations in the report, the authors stated, should be finalized by the end of 2015.

Dr. Lane and Dr. Altman said that they had no relevant financial disclosures.

The report is available from the IOM website.

Rheumatologists are on the front lines of pain management, yet they were not consulted by the Institute of Medicine committee that wrote a comprehensive new report on pain.

An estimated 25 million Americans have osteoarthritis and 1.7 million have rheumatoid arthritis, according to the National Institute of Arthritis and Musculoskeletal Diseases. Arguably, these figures place rheumatologists at the eye of the nation’s pain storm.

The report "ignores the fact that there are different types of pain specialists. When they talk about a pain specialist, they are talking about an anesthesia-oriented pain specialist, not those who deal with pain as a specialty, like rheumatology or neurology," Dr. Roy Altman said in an interview. "Because this report was [written by] a predominance of anesthesiologists, a couple of pediatric people, one neurologist, plus a lot of epidemiologists, it doesn’t really approach the people on the front line who are dealing with the pain."

The author specialties are more procedure-oriented toward pain, Dr. Altman said, versus the more nonpharmacologic and pharmacologic approaches taken by internists, other primary care physicians, and rheumatologists.

A greater awareness of pain and its adverse health consequences, improved patient education and self management, and an increased emphasis on prevention are major strategies in a comprehensive new report on pain from the Institute of Medicine (IOM).

Health care providers are among those the report authors task with fostering a transition to better pain management in the United States. "Among steps to improving care, health care providers should increasingly aim at tailoring pain care to each person’s experience, and self management of pain should be promoted. Also, primary care physicians – who handle most front-line pain care – should collaborate with pain specialists in cases where pain persists," according to a brief of the report.

This collaboration is "critical," Dr. Nancy E. Lane said in an interview. "Patients with chronic pain seek out a number of different physicians, the care is not coordinated, and the patients can suffer." Dr. Lane is professor of medicine and rheumatology at the University of California, Davis and director of the UC Davis Center for Healthy Aging.

As part of the 2010 Patient Prevention and Affordable Care Act, the U.S. Department of Health and Human Services charged the IOM with assessment of the state of pain in the United States from a public health perspective. The 19 committee members also prioritized strategies for improvements in the "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" report, released in June.

"There is one major problem with the report, and that is the selection of people [who] wrote it. There are no primary care physicians and there are no rheumatologists involved," Dr. Altman, professor emeritus of rheumatology at the University of California, Los Angeles, said in an interview. "In other words, it excludes a lot of the people who treat pain."

The report "won’t change anything in my specialty," Dr. Altman said. "Rheumatologists, as a group, have already titled ourselves as the specialists for pain for the rheumatic diseases.

Dr. Lane was a bit more positive about the impact of the report. "It reminds me to always be vigilant about taking a thorough pain history and talking to my patients about their pain, how they are managing it, and filling in the gaps."

The committee estimated that 116 million Americans experience chronic pain. They state the cost of medical treatment and lost productivity associated with pain in the United States is an estimated $635 billion each year. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy, the authors stated.

Strategies include:

• A heightened awareness of pain and its health consequences.

• An emphasis on the prevention of pain.

• Improved pain assessment and management within federal health care and financial programs.

• Patient education on management of their own pain through public health communication strategies.

• Decreasing disparities in the pain experience among subgroups of Americans.

The emphasis on patient self-management of pain also is critical, Dr. Lane said. "Education on pain and how to treat it will empower the patients, just as the arthritis self-help classes have done for years. They improve self efficacy."

"You cannot control pain if the patient does not deal with it," Dr. Altman agreed. "If a patient doesn’t have an investment and take control of their pain, they are not going to get better."

"Fibromyalgia is so prominent throughout the country," he added, "that to think about not having the patient invested in their pain control is really an exercise in futility."

Improvement of pain management and prevention efforts among underdiagnosed and/or undertreated subpopulations is another tenet of the report. Those at risk include surgery and cancer patients; people at the end of life; racial and ethnic minorities; people with lower income and education levels; women, children, and older people; and military veterans. This need is not unique to pain, Dr. Altman said. "That same disparity exists in all medical care. People who are at risk for not having pain control are the people who are at risk for not getting medical care. It’s the same population."

Strategies to reduce barriers to pain care are among the recommendations that should be implemented by the end of 2012, the report committee said. Support of greater collaboration between pain specialists and primary care clinicians also should be established by the end of next year.

In addition, an existing institute within the National Institutes of Health should become the lead institute and responsible for moving pain research forward as well by the end of 2012, the report states. The NIH Pain Consortium also should take a stronger leadership role in fostering the necessary research. Dr. Altman was somewhat pessimistic about these proposals. "They make a recommendation in here that the NIH devotes some specific groups to pain control. Good luck with that in this financial climate."

Ongoing efforts to enact the remaining recommendations in the report, the authors stated, should be finalized by the end of 2015.

Dr. Lane and Dr. Altman said that they had no relevant financial disclosures.

The report is available from the IOM website.