David A. Thomas, Ph.D. NIDA/NIH Pain Consortium

Transcription

1 Research on Pain Management and Education at the National Institutes of Health: Response to the 2011 IOM Report Relieving Pain in America David A. Thomas, Ph.D. NIDA/NIH Pain Consortium

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3 About 100 million Americans suffer the agony of chronic pain

4 It costs $560-$630 BILLION every year

5 Americans in Chronic Pain!! 100,000,000 IOM, ,000,000 APS, 1999

6 Marked Geographic Variation in Mortality: Estimated Ageadjusted Death Rates for Drug Poisoning by County 1999 Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System; Tom Frieden Presentation at the Opioid Summit, Atlanta, April 2016

7 Marked Geographic Variation in Mortality: Estimated Ageadjusted Death Rates for Drug Poisoning by County 2002 Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System; Tom Frieden Presentation at the Opioid Summit, Atlanta, April 2016

8 Marked Geographic Variation in Mortality: Estimated Ageadjusted Death Rates for Drug Poisoning by County 2005 Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System; Tom Frieden Presentation at the Opioid Summit, Atlanta, April 2016

9 Marked Geographic Variation in Mortality: Estimated Ageadjusted Death Rates for Drug Poisoning by County 2008 Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System; Tom Frieden Presentation at the Opioid Summit, Atlanta, April 2016

10 Marked Geographic Variation in Mortality: Estimated Ageadjusted Death Rates for Drug Poisoning by County 2011 Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System; Tom Frieden Presentation at the Opioid Summit, Atlanta, April 2016

11 Marked Geographic Variation in Mortality: Estimated Ageadjusted Death Rates for Drug Poisoning by County 2014 Designed by L. Rossen, B. Bastian & Y. Chong. SOURCE: CDC/NCHS, National Vital Statistics System; Tom Frieden Presentation at the Opioid Summit, Atlanta, April 2016

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14 The Necessary Cultural Transformation Conclusion. Chronic pain alone affects the lives of approximately 100 million Americans, making its control of enormous value to individuals and society. To reduce the impact of pain and the resultant suffering will require a transformation in how pain is perceived and judged both by people with pain and by the health care providers who help care for them. The overarching goal of this transformation should be gaining a better understanding of pain of all types and improving efforts to prevent, assess, and treat pain.

15 Finding 2-1. Pain is a public health problem. Finding 2-2. More consistent data on pain are needed. Finding 2-3. A population-based strategy for reducing pain and its consequence is needed Improve the collection and reporting of data on pain Create a comprehensive population health-level strategy for pain prevention, treatment, management, and research.

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17 The National Pain Strategy Oversight Panel Public Education & Communication High quality, evidence based education programs for patients and the public Professional Education Improve professional education of all providers Prevention & Care increase substantially the accessibility and quality of pain care. Services & Reimbursement Public health entities have a role in pain care and prevention Disparities under-treatment and inappropriate treatment of pain among racial and ethnic minorities Population Research Improvements in state and national data are needed

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19 Opioid Prescribing Guidelines

20 Finding 3-1. Pain care must be tailored to each person s experience. Finding 3-2. Significant barriers to adequate pain care exist Promote and enable self-management of pain Develop strategies for reducing barriers to pain care Provide educational opportunities in pain assessment and treatment in primary care Support collaboration between pain specialists and primary care clinicians, including referral to pain centers when appropriate Revise reimbursement policies to foster coordinated and evidence-based pain care Provide consistent and complete pain assessments.

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22 How bad is your fever, where 0 is no fever and 10 is the worst fever you have ever had??? 0 10 vs.

23 Finding 4-1. Education is a central part of the necessary cultural transformation of the approach to pain Expand and redesign education programs to transform the understanding of pain Improve curriculum and education for health care professionals Increase the number of health professionals with advanced expertise in pain care.

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26 Group 1 (n=28) (not exposed to CLBP module) Group 2 (n=27) (exposed to CLBP module) P value CLBP OSCE score (mean, s.d.) <.001 Non-CLBP OSCE score (mean, s.d.) Palpitations Pediatric ear exam ACE inhibitor Sinus infection Anticipatory guidance Adult abdominal pain Pediatric abdominal pain Hypertension treatment Pediatric prescription writing

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28 Finding 5-1. Research to translate advances into effective therapies for pain is a continuing need Designate a lead institute at the National Institutes of Health responsible for moving pain research forward, and increase the support for and scope of the Pain Consortium Improve the process for developing new agents for pain control Increase support for interdisciplinary research in pain Increase the conduct of longitudinal research in pain Increase the training of pain researchers.

29 Choose between pain treatment VERSUS reduce prescription opioid abuse PAIN!!! Prescription Opioid Abuse!!!

30 Improve Pain Treatment AND Reduce Prescription Opioid Abuse PAIN!!! POA!!!

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32 Research on Pain Management and Education at the National Institutes of Health: Response to the 2011 IOM Report Relieving Pain in America David A. Thomas, Ph.D. NIDA/NIH Pain Consortium