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Treating Pain Must Be Key Part of Health Reform Bill

When the House of Representatives passed the Affordable Health Care for America Act on Nov. 7, it rightfully included several elements of the National Pain Care Policy Act of 2009 (NPCPA). While only one prong of the much larger effort to reform health care in this country, it contains several of the first steps we need to take to improve care and reduce costs in treating pain. [IMGCAP(1)] Among its provisions, it would provide training in pain management for health professionals, who currently get no more than a couple of hours of pain training — nowhere near enough to deliver good pain care. It calls for more funding for pain research. Currently, less than 1 percent of the National Institutes of Health budget is dedicated to this research. With lasting and chronic pain affecting more Americans than diabetes, heart disease and cancer combined, this will improve the lives of the one in four Americans whose pain is undertreated and mismanaged.Derek McGinnis is one of these Americans. After surviving a bomb that was detonated by a suicide bomber near the city of Fallujah in 2004, Derek returned home from Iraq without a leg — and in horrific pain.As efforts to reform health care continue for the next several weeks, we need to remember Derek and the tens of thousands of other veterans who have returned from the conflict in Iraq only to suffer from unrelenting, chronic pain. As pain specialists, we see people every day who are valiantly coping with pain. And as the co-chairs of a national panel that recently released a report on chronic pain, we know that our recommendations, which in some cases mirror the recommendations in the NPCPA, will ensure relief for millions of Americans — not just those with traumatic injuries.Many of these Americans have back pain. Some are afflicted with arthritis. Even more suffer from headaches or migraines. And thousands more suffer from the pain associated with cancer.In fact, chronic pain costs the nation more than $100 billion annually for direct medical care, lost income and lost productivity. Yet as the report notes, this nation has failed to recognized chronic pain as an illness in its own right. Even worse, the United States has an inefficient, even wasteful system for dealing with chronic pain, a system that leaves veterans and civilians alike to suffer — often for years without relief.We simply must find a way to improve a system of care that is often ineffective and sometimes inhumane, and costs way more than it should. How?Policymakers need to ensure that after all of the negotiating and politicking of reform is done, the provisions of the NPCPA remains a part of the final bill.The national panel convened by the Mayday Fund identified an alarmingsituation: Doctors and other health professionals don’t have enough knowledge about the biology of chronic pain and they don’t know enough about drugs and other treatments that can offer effective pain relief, especially for people in chronic pain. Patients with pain may be stigmatized, particularly those who receive narcotic drugs.The end result: People in pain often bounce from doctor to doctor and get unproven treatments, or procedures that do nothing to deal with the underlying pain. Years can go by before they get a comprehensive evaluation and a plan of care appropriately targeting pain and disability.Without effective care, people with unrelenting pain are at risk for depression, job loss and even suicide. Pain that goes untreated for months or years can morph into a chronic condition that undermines every aspect of life.Veterans, boomers and others are aging and developing a host of chronic conditions that can cause ongoing pain. If we do nothing to fix the inefficient system of dealing with pain, the current 76 million Americans in chronic pain will continue to grow, and both the personal and economic costs associated with pain will become astronomical.Our panel identified a number of recommendations that would go a long way toward fixing this crisis. Specifically, the NIH must boost funding so that scientists can find more effective treatments and ways to prevent acute pain from becoming a chronic condition.Medical students, and other health professionals, must get additional training so that they can evaluate chronic pain, effectively use the dozens of pain relieving medications on the market and guide patients in the use of non-drug therapies.They must also be trained to offer comprehensive care that integrates medical, behavioral and other types of treatment.The nation should follow the lead of the Veterans Administration, which has created a National Office of Pain Management. This office helps veterans get the kind of comprehensive care that offers real relief.McGinnis finally got that kind of care, and after years of unbearable pain, he’s now actively living life again, including competing in endurance races.Let’s give all Americans a fighting chance to lead lives that aren’t disabled by chronic pain.Russell K. Portenoy, M.D. is the chairman of the Department of Pain Medicine & Palliative Care at the Beth Israel Medical Center and a professor of Neurology & Anesthesiology at Albert Einstein College of Medicine in New York. Lonnie Zeltzer, M.D., is a professor of Pediatrics, Anesthesiology, Psychiatry & Biobehavioral Sciences at the David Geffen School of Medicine at the University of California, Los Angeles. She is also the director of the Pediatric Pain Program at Mattel Children’s Hospital, UCLA.Dr. Portenoy and Dr. Zeltzer are co-chairs of an expert Mayday Fund Committee that recently released a report, “A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform,” which can be found at

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