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US Senate Addresses Chronic Pain in First Hearing

Allison Shelley
medscape.com
February 16, 2012 — The US Senate confronted the growing epidemic of chronic pain in a landmark hearing held in Washington, DC, on February 14. According to the Institute of Medicine, pain is affecting 116 million Americans, at an annual cost of $635 billion.

The hearing, called by the Committee on Health, Education, Labor and Pensions, explored disparities in research, education, and patient care. This is the same committee that backed the recent Institute of Medicine report showing that the country has a long way to go to relieve this health problem.


Senator Tom Harkin

Committee chair Senator Tom Harkin, a Democrat representing Iowa, and ranking member Senator Mike Enzi, a Republican representing Wyoming, are leading the initiative.

"Chronic pain is a significant public health problem that has yet to receive adequate attention, given the tremendous impact it has on people all across our nation," Sen. Harkin said.

"It remains one of the most challenging conditions to assess and effectively treat," he added, "even though it's one of the top reasons for doctors' visits. Because of the pervasive impact of chronic pain, we have convened this important hearing today to explore the current state of research, care, and education with respect to chronic pain; to examine barriers associated with treatment; and to discuss opportunities for further research and prevention strategies."

Senator Mike Enzi

The experts giving testimony at this hearing will approach this problem from a variety of perspectives, he said, "all with the goal of addressing this critical but often neglected public health issue — and this is a public health issue — and what it costs this country, both in terms of dollars but in terms of lost productivity and lost quality of life."

It is a complicated time for pain management. Prescription drug overdose death rates in the United States are at an all-time high. There are more fatalities from opioid overdoses than from heroin and cocaine overdoses combined. In some states, these rates are higher than deaths from car crashes. In addition to the clear human costs, an estimated 60% of hospital costs related to opioid overdoses are paid for with public funds.

Legislators and physicians are wrestling with how best to strike a balance between protecting the public and ensuring that legitimate patients receive adequate care.

The number used when discussing this issue — 116 million Americans who have pain that persists for weeks to years — does not include children or people in nursing homes or chronic care facilities, prisons, or the military, Philip Pizzo, MD, from Stanford University School of Medicine in California, pointed out at the hearing.

"The scope of the problems in pain management is daunting, and the limitations in the knowledge and education of healthcare professional are glaring," he said. "The medical community must actively engage in the necessary cultural transformation to reduce the pain and suffering of Americans."

As reported by Medscape Medical News at the time, the 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services to study chronic pain. The report, funded by the National Institutes of Health, found there is a need for coordinated, cross-country efforts to change attitudes toward pain.

Speaking at the hearing, Lawrence Tabak, DDS, PhD, principal deputy director of the National Institutes of Health (NIH) and coleader of the NIH Pain Consortium, said, "We strongly support the report's emphasis on greater interdisciplinary coordination at both the policy and research level."

Although chronic pain can accompany many diseases, Dr. Tabak said, "Perhaps the most important modern insight is that chronic pain, however it begins, can also become a disease in and of itself. Changes in the brain and elsewhere in the nervous system can cause pain to persist long after it has any adaptive value."

This recognition of chronic pain as a disease, together with an increased understanding of the maladaptive physiological and psychological changes that underlie the persistence of pain, "have important implications for how we study pain, treat pain, and structure our healthcare systems to provide care to patients suffering from pain," he explained.

"The Institute of Medicine report and today's hearing give us renewed hope," added Christin Veasley, a chronic pain sufferer and executive director of the National Vulvodynia Association. "Hope that our country is listening to us, cares about our plight, and is ready to enact long-overdue change to help us regain some semblance of quality of life and return to contributing to society."

The American Headache Society applauds the Senate committee for what it says is a timely hearing on a "groundbreaking" report.

"This hearing marks the next step in the long march to better pain care in this country," society president David Dodick, MD, from the Mayo Clinic in Phoenix, Arizona, said in a news release.

The American Academy of Pain Medicine participated in a public session leading up to the Institute of Medicine report. The academy has advocated for improved education and training of physicians in pain management.

The American Pain Society has also backed the Institute of Medicine report, calling it, "A major step forward in addressing the nation's leading health problem — untreated and undertreated chronic pain."


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