American Pain Foundation PAIN POLICY AND PRACTICE THE PATIENT S’ PERSPECTIVE NPF Workshop October 23 rd, 2008 Will Rowe, CEO The American Pain Foundation

Pain and Objectivity The “science “ of medicine cannot detect pain The necessity of relying on patient report “Its all in your head” “Nothing shows up on your tests, you can’t be in pain.” Pain is complex, difficult to assess and difficult to treat and the pain patient is one of the least favorite patients to treat LISTENING and VALIDATION

THE MEDICAL SYSTEM Poor training and education for health professionals in assessment and treatment of pain Few physicians understand pain as disease The specialty silos---neurologists, rheumatologists, anesthesiologists, psychiatrists, interventionalists, psycho-behavioralists, CAM The Pain Care Medical System is fragmented, confusing, with little support for excellent medical care encouraged by the payment systems

The Complexity of Pain Different types of pain Different biochemical-mechanisms of pain Pain ALWAYS includes a psychological dimension----fear, depression, anxiety. Cultural, spiritual, social dimensions of pain Best treatments are multi-dimensional, multi-disciplinary

PAIN DISORDERS--SHORTLIST Back pain, headaches, neck pain, arthritis (RA/OA), cancer pain, fibromyalgia, complex regional pain syndrome, trigeminal nerve disorder, diabetic neuropathy, peripheral neuropathy, vulvodynia, interstitial cystitis, shingles, post herpetic neuropathy, chemotherapy induced neuropathy, lupus, arachnoiditis, etc

OPIOID MEDICINES What do you do if your pain is moderate to severe?-----NSAIDs and other over the counter medicines do not work Opioid medicines (not “narcotics”) are some of the most effective and safe medicines when appropriately used. What is appropriate use? The need to train HC providers in the appropriate use of these medicines.

OPIOD MEDICINES (continued) Understanding differences between “abuse,” “misuse,” “dependence,” “tolerance,” “addiction.” The War on Drugs vs The War on Pain

THE WARS “….the collision between the War on Pain and the War on Drugs has created the ‘perfect storm’ of controversy.” Scott Fishman, M.D. “The War on Drugs has become the war on pain patients and their doctors.” “Improving pain care in America has had the unintended consequence of fueling the problem of abuse and addiction”

TREATMENT OPTIONS Creating understanding and access to breadth of treatment options Access challenges: disparities, insurance and payments. “Step-Protocols”—erecting barriers to access to treatments

THE SOLUTIONS Significantly increase HC provider skill and understanding of the assessment and treatment of pain Create balanced policies and balanced practice approaches to utilizing opioid medicines Educate and support pain patients in understanding and utilizing treatment options

THE SOLUTIONS (continued) Align coverage and payment systems with best practice pain care Significantly increase investment in pain research