A chance to transform pain care in the USA
2015; Elsevier BV; Volume: 14; Issue: 6 Linguagem: Inglês
10.1016/s1474-4422(15)00062-9
ISSN1474-4465
Autores Tópico(s)Pain Management and Opioid Use
Resumo“Effective pain management is a moral imperative, a professional responsibility, and the duty of people in healing professions”, according to the US Department of Health and Human Services (HHS) draft National Pain Strategy. The draft strategy is available for public comments until May 20, 2015, and feedback is encouraged from individuals and organisations interested in understanding pain and improving pain treatment, including health-care professionals, researchers, patients, and the pharmaceutical industry. Neurologists in the USA and elsewhere should not miss the opportunity to shape the strategy, which has the potential to bring much needed change not only to the lives of people with chronic pain but also to the way physicians, including neurologists, manage the care of these patients. Acute pain is a physiological response that usually ends when the noxious stimulus is removed. But sometimes pain can become chronic, defined by the International Association for the Study of Pain (IASP) as pain on at least half of days for at least 6 months. Chronic pain can be inflammatory (when factors from inflamed tissue sensitise nociceptive pathways), neuropathic (when pain pathways are damaged), idiopathic, or attributed to a combination of these mechanisms. Peripheral neuropathic pain includes postherpetic neuralgia and diabetic and HIV neuropathies; central neuropathic pain affects about 8% of patients with stroke, 25% with multiple sclerosis, and 40–50% with spinal cord injury. Many people with chronic pain are first seen by primary care physicians or specialists such as oncologists but many are assessed or cared for by neurologists at some stage. The 2010 Patient Protection and Affordable Care Act in the USA required the HHS to “increase the recognition of pain as a significant public health problem”. The Institute of Medicine (IOM) was commissioned to assess pain care and in 2011 published its report Relieving Pain in America. According to the report, chronic pain (not necessarily high-impact pain) is estimated to affect about 100 million people in the USA and to cost up to US$635 billion per year. The report also called for a “comprehensive population health-level strategy for pain prevention, treatment, management, and research”, and in 2012 the NIH, on behalf of the HHS, established the Interagency Pain Research Coordinating Committee (IPRCC) to oversee activities and devise the national strategy. The resulting strategy sets out 17 objectives to address deficiencies in six overlapping areas: population research, prevention and care, disparities, service delivery and reimbursement, professional education and training, and public education and communication. Several objectives address the need for more data on the prevalence of chronic pain, its impact on patients, and the extent and costs of strategies for prevention and management. Other objectives target reimbursement practices and fragmented service provision, which discourages preventive intervention and multidisciplinary care; a stepped model of care is recommended, which favours self-management by patients where possible, and multidisciplinary care for people with high-impact pain. Education and access to information are also priorities: inadequate training for health-care professionals currently leads to under or over treatment and patient dissatisfaction, and public education is needed to reduce stigma and the risk of addiction to pain-relieving drugs. Disparities in access to care are also set to be targeted, as people with chronic pain seem even less likely to receive support and treatment if they are from an ethnic minority, are an elderly patient in a nursing home, or have pain linked to chronic fatigue or HIV. For progress to be made, much more will need to be known about the pathophysiology of chronic pain and how it should be prevented and managed. The NIH has already shown a commitment to pain research: its blueprint initiative for neuroscience includes a grand challenge on the transition from acute to chronic pain and, according to the IPRCC research portfolio database, more than 2000 pain research projects were funded by federal agencies and departments in 2011 and 2012 (projects funded in 2013 and 2014 should be listed later this year). However, the extent to which new funding will be available for the projects outlined in the strategy is not yet clear. Also, although the objectives are broken down into those for the short-term, medium-term, and longer-term, target periods are not obviously defined. The 2011 IOM report called for a “cultural transformation in pain care, prevention, education, and research”. If its ambitious objectives can all be met, the draft strategy could be a big step towards this goal, and if you want to have a say on the transformation process be sure to add your comments. For Relieving Pain in America see http://www.iom.edu/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-transforming-Prevention-Care-Education-Research.aspx For Relieving Pain in America see http://www.iom.edu/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-transforming-Prevention-Care-Education-Research.aspx
Referência(s)