The IPRCC will develop a comprehensive population health level strategy for pain prevention, treatment, management, and research
The IPRCC was charged by the Office of the Assistant Secretary for Health to create a comprehensive population health level strategy for pain prevention, treatment, management, and research. This strategy is a core recommendation of the 2011 IOM Report: Relieving Pain in America (Recommendation 2-2): "The Secretary of the Department of Health and Human Services should develop a comprehensive, population health-level strategy for pain prevention, treatment, management, education, reimbursement, and research that includes specific goals, actions, time frames, and resources." The IOM report highlighted specific objectives for the strategy:
1. Describe how efforts across government agencies, including public- private partnerships, can be established, coordinated, and integrated to encourage population-focused research, education, communication, and community-wide approaches that can help reduce pain and its consequences and remediate disparities in the experience of pain among subgroups of Americans.
2. Include an agenda for developing physiological, clinical, behavioral, psychological, outcomes, and health services research and appropriate links across these domains (consistent with Recommendations 5-1 thru 5-4).
3. Improve pain assessment and management programs within the service delivery and financing programs of the federal government.
4. Proceed in cooperation with the Interagency Pain Research Coordinating Committee and the National Institutes of Health's Pain Consortium and reach out to private-sector participants as appropriate.
5. Involve the following agencies and entities
- Federal agencies and departments
- National Institutes of Health
- Centers for Disease Control and Prevention
- Food and Drug Administration
- Centers for Medicare and Medicaid Services
- Agency for Healthcare Research and Quality
- Health Resources and Services Administration
- Indian Health Service
- Department of Defense
- Department of Veterans Affairs
- Private-sector entities
- Pain advocacy and awareness organizations
- Health professions associations
- Health care providers (e.g., accountable care organizations)
- Health professions educators, colleges, and training programs
- Private insurers
- Accreditation (e.g., Joint Commission, National Committee for Quality Assurance), certification (e.g., American Board of Medical Specialties), and examination (e.g., National Board of Medical Examiners) organizations
- Health professions licensing authorities
- State-level entities
- Workers' compensation programs
- Medicaid programs
- State health departments
6. Include ongoing efforts to enhance public awareness about the nature of chronic pain and the role of self-care in its management.
The IPRCC has developed a framework to address the IOM recommendation 2.2. To ensure the development of a progressive, integrated strategy with practical goals, the IPRCC plans to establish an Oversight Group to coordinate and integrate the efforts of five focused working groups. The working groups will be structured to address the objectives outlined in the IOM report that relate to recommendation 2.2. These groups and the problems they will address are described below.
Professional Education and Training
The problem: curricula for health care professionals lack adequate materials on pain prevention and treatment . Despite the significant responsibility that health care professionals have for pain patients, many health professionals, especially physicians, are inadequately prepared and require greater knowledge and skills to contribute to the cultural transformation in the perception and treatment of people with pain.
Public Education and Communication
The problem: Education is a central part of the necessary cultural transformation of the approach to pain. High quality, evidence based education programs for people with pain and the public that are designed to promote a transformation in their expectations, beliefs, and understanding about pain, its consequences, its management, and its prevention are needed to make the transformation.
Public Health: Care, Prevention, and Disparities
The problem: People's experience with pain touches the entire health care system and many aspects of life. Only a cultural transformation could increase substantially the accessibility and quality of pain care. Cultural perspectives influence reports of pain in general and within specific racial/ethnic groups. Available data substantiate under-treatment and inappropriate treatment of pain among racial and ethnic minorities, those with mental health problems, and those perceived as inappropriately seeking drug prescriptions, for a wide range of settings, illness, or injury. These disparities also are seen for women versus men and in different socio-economic strata.
Public Health: Service Delivery and Reimbursement
The problem: Public health entities have a role in pain care and prevention because of the high utilization of publicly funded service delivery programs (e.g. community service programs, public housing, rural and migrant health centers, services for the homeless, the IHS, and the Native Hawaiian Health Care Systems Program). Aside from its role in direct service delivery, the public health establishment reimburses for care in nonpublic settings, including hospitals, doctors' offices, and pharmacies.
The problem: Improvements in state and national data are needed to (1) monitor changes in the incidence and prevalence of acute and chronic pain; (2) document rates of treatment or under-treatment of pain and restrictions to treatment options; (3) assess the health and societal consequences of pain; and (4) evaluate the impact of related changes in public policy, payment, and care.