IOM Pain Report Relieving Pain in America Gets Mixed Reviews

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Institute of Medicine (IOM) studies pain in America

Seat does not recline signThis past summer, the Institute of Medicine (IOM) produced a report on the status of pain treatment in America called Relieving Pain in America: A Blueprint for Transforming Prevention, Treatment, and Research. (You can download a prepublication PDF of the book at that link.) The report recommended to the U.S. Department of Health and Human Services as a “blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America.”

One of the most important results is the call for greater research in the area of pain: “Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments.”

Summary of Institute of Medicine (IOM) “pain report”

Musculoskeletal Network has an excellent summary of Relieving Pain in America. Important points include the following:

  • Transforming the way pain is understood
  • NIH should lead in pain research
  • Pain is a public health problem

Rheumatology responds to the IOM pain report

Now, it gets more interesting.

The August issue of Rheumatology News contained a stunning criticism of the pain report: IOM Report on Pain Ignores Rheumatologists: Primary care physicians also left off policy panel dominated by anesthesiologists and epidemiologists. None of the 19 committee members were rheumatologists. “Rheumatologists are on the front lines of pain management, yet they were not consulted by the Institute of Medicine committee that wrote a comprehensive new report on pain.”

Rheumatology News criticizes the overlooking of rheumatologists because, according to Dr. Roy Altman, “Rheumatologists, as a group, have already titled ourselves as the specialists for pain for the rheumatic diseases.”

Why “ignore” rheumatologists, as they say? Good question.

I have two questions:

  1. Why do a large percentage of rheumatology patients say that their rheumatologist does not treat pain related to their rheumatological disease? Not all, of course, but an apparent majority.
  2. Why have there been several rheumatological studies which minimize the physical pain of Rheumatoid Disease which is historically known to be exceedingly painful, claiming that RA patients just have a poor tolerance to pain?

Why leave out rheumatology? Are the questions are connected in some way?

Postblog: One more twist. The Rheumatology News piece includes this: “You cannot control pain if the patient does not deal with it,” Dr. Altman agreed. “If a patient doesn’t have an investment and take control of their pain, they are not going to get better.” This might make sense with some conditions, but lifestyle modification to “take control” does not routinely improve RA. If “taking control” of pain could help us “to get better,” I doubt most of us would live with the high level of pain that we do. Unfortunately, RA is progressive and destructive even in assertive, healthy people who fight back; and a limited degree of the outcome is in their control.

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Kelly Young. All rights reserved.

This entry was posted on Thursday, October 6th, 2011 at 6:00 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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