by Myra Christopher

blog-myra-books-webRecently, a friend and colleague who is a faculty member of a medical school that is transitioning to an entirely digitized library told me that they were giving away all their hard-bound books and asked me if I would like for her to retrieve some of those focused on chronic pain.  I’m not sure if she brought me all books on this topic or just those that she thought I would be interested in and/or that she could carry.  She brought me 30 books copyrighted from 1977-2005.  The shortest is just under 150 pages and the longest just over 1500 pages — a total of 13,734 pages.

My first pass at trying to figure out how they could be of benefit to PAINS was to sort them by copyright — that’s what the orange sticky notes in the attached photo connote.  Then I thought it would be interesting to look in the back of each book to find out how many times they had been checked out and by whom. To my surprise many, if not most of them, had never been opened; they “cracked” when I opened them — even the one authored by the Dean of the Medical School. Interestingly, the book that had been checked out the most was Killing Pain Without Prescription copyrighted in 1980 by Harold Gelb, D.M.D. which was  published by Harper & Row. It had been checked out five times — once by a dental school, once by an occupational therapist and three times by two students (I presume one student found two weeks too little to handle 247 pages).

The dedication at the front of Killing Pain Without Prescription reads, “To all the unfortunate chronic pain patients, many of whom can now look forward to a life free of suffering.”   In the acknowledgement, Dr. Gelb wrote:

A book of this scope must attempt to overcome some of the shortcomings of our traditional, specialized health care system by crossing specialty and professional boundaries.  Scientific  isolationism undermines the development of a holistic approach to diagnosis and treatment of pain and dysfunction, the need for which is such a pressing problem for many individuals.  Consequently, we found it necessary to confer with health professionals in many diverse fields to present a multi-disciplinary approach to this multi-factored disorder.

He then proceeds to list those with whom he collaborated.  Killing Pain Without Prescription then begins, “This is a book of hope.”  Really?

Written nearly three and a half decades ago, these words could easily have been written yesterday with one exception, the term “multidisciplinary” has now been replaced by “inter-disciplinary.”   And those living with chronic pain today would surely find his dedication laughable.  However, I do believe there is reason for optimism.

In a matter of weeks, the National Pain Strategy (NPS) Report called for in the Institute of Medicine’s report, Relieving Pain in America, will be published in the Federal Registry, and people will be asked to provide input and comment.  By early fall, it is expected that the plan will be released.  No doubt, it will include some of the same verbiage Gelb used.  It has been my privilege to serve on the NPS Oversight Committee, and I believe that it will be a catalyst for the “cultural transformation in the way pain is perceived, judged, and treated” called for in the IOM report.

So, why do I think things will begin to change now?

With the passage of the Affordable Care Act, I believe the stars began to align.  Our healthcare delivery system is in the biggest transformation since the passage of Medicare in 1965 because serious policymakers (not politicians) at every level know that we do NOT have the best healthcare system in the world.  We do, however, have the best trained healthcare professionals and the most technological capacity.  And we do spend more on healthcare than any other country in the world, but when you look at health status, health outcomes, costs, or patient and provider satisfaction, we are not doing so well.  Many leaders and policymakers have come to realize that significant change is called for, especially regarding the treatment of chronic pain.

At least one hundred million Americans live with chronic pain — more than all those with cancer, heart disease and diabetes combined — making chronic pain one of the most important public health issues facing our country. In humanistic terms, the costs are incalculable. People lose jobs, insurance coverage, their families, even a sense  of who they are. In economic terms, the costs are staggering — $560-635 billion annually when the costs of treatment are combined with loss of productivity, and the federal government foots the bill for nearly $100 billion each year.

For decades, we have had data indicating that a comprehensive approach to chronic pain, what we referred to in the IOM report as a “bio-psychosocial approach” produces better outcomes at a lower cost, but we have ignored those data in large part because tremendous money has been made in chronic pain care, and we didn’t know how to change the system. I believe that now we do know how to change the system  and the incentives are properly aligned for the necessary change.

More than 80 individuals have served on the National Pain Strategy Oversight Committee or one of its work groups. They have spent a tremendous amount of time and effort to develop a plan for changing the way “pain is perceived, judged and treated.”  Those include changes in the way our society perceives chronic pain and those who struggle to live with it, changes in the physician/patient relationship, changes in the way those in the healing professions are trained, changes in research, and changes in the way we reimburse those who treat chronic pain.

To paraphrase Dr. Gelb, “This is a plan of hope,” and it is my fervent hope that all who read this will become engaged in making the plan a reality. Please begin by taking time to review the National Pain Strategy Report and sharing your thoughts and ideas about it.

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