14by Myra Christopher

As a member of the Institute of Medicine’s committee that published Relieving Pain In America and director of PAINS (the Pain Action Alliance to Implement a National Strategy), I was not surprised by Rick Montgomery’s article in the Kansas City Star which appeared on June 5th, Baby boomers have the highest rate of suicide, nor that two of the people he featured had struggled with chronic pain prior to taking their own lives.  Suicide rates for chronic pain patients are 2.5-4 times higher than that of the general population. Although, as Montgomery’s article states, “tracking suicide over the years is problematic,” it is widely believed that the younger the chronic pain patient is, the more likely he or she is to commit suicide.

At least 100 million Americans live with pain at various rates of severity.  For those with unrelenting pain, this condition can be life-threatening.  Yet, those with chronic pain struggle to access the care they need and are often treated as though their problem is “all in their head”, as drug seekers, or as malingerers who wish to avoid work. Actually, current neuroscience research indicates that chronic pain can be viewed as a “brain disease” since permanent changes in brain function have been observed related to unremitting noxious stimulation to the brain.

Community and State-Based Initiatives

One of PAINS’ strategic goals is to develop, support and network community and state-based initiatives focused on “transforming the way pain is perceived judged and treated.”  A pilot community project, Relieving Pain in Kansas City, which began more than a year ago, attempts to serve as the catalyst for this “transformation.”   A statewide initiative being led by the School of Public Health at Texas A&M is in the early stages of formation in South Texas, and the PAINS leadership team has been in conversation with others about similar projects in Michigan, California, New Hampshire and Iowa.

These projects are based on a community-health development partnership approach. The “partnership approach” is a community health development process that operates by simultaneously organizing in a community at multiple levels—both resource holders and grassroots leaders are involved. In practice, the partnership approach recognizes the social determinants of health and the value of a social ecological perspective in a collaborative problem-solving process that incorporates the enlightened self-interest of individuals, public and private organizations and institutions, health and human service providers, insurers, employers, and governmental.  It is an effective method for planning, implementing, evaluating, and sustaining health and human service systems across a full continuum of care. Ultimately, its simultaneous goals are increased community capacity and population health improvement regardless of the initiative’s focus.

The partnership approach seeks to build relationships among people and different sectors of the community (e.g. health and human service providers and payers [insurers], education, the private sector [employers], government at all levels, civic and faith-based groups, and local media) and linking them with resources and sectors outside the community. In essence, the partnership approach serves as a linkage for establishing new relationships or reinventing older associations, an important aspect of helping populations and organizations arrive at agreeable solutions to difficult problems in the public domain. The common objective is the planning, development, implementation, and evaluation of initiatives to improve health, based on a shared local vision for health improvement.  The Partnership Approach for Community Health Improvement was first implemented in the County Health Improvement Project of Lycoming County, Pennsylvania between 1978 and 1984 . Since that time it has been refined and utilized extensively.

Michael Felix

Michael Felix

PAINS is fortunate to have Michael Felix as its Community-health development director and to work with Jim Burdine the Interim Dean of the School of Public Health at Texas A&M who, with Felix, developed this approach more than thirty years ago, and since then, has validated it in dozens of communities across the country. With their leadership and that of others including  doctors, those living with chronic pain and their families, hospital administrators, payers, communication experts and policymakers, PAINS is working at the community and state levels to shift the standard of care for chronic pain from a bio-medical model — pills and nerve blocks — to a patient-centered bio-psychosocial approach.

Those living with chronic pain must believe that change is coming.  They must have realistic hope that we can do better than the status quo.  In fact,  change must come;  lives are at stake! 


Read the latest on our community and state-based initiatives