Chronic pain is present in epidemic proportions in most countries, is often unrelieved, and has a huge socioeconomic impact. It is not just a “medical” illness but indeed is a problem that faces all healthcare professional fields. Several steps are identified to address this crisis. These include approaches to enhance pain awareness and access to timely and effective care for pain, and educational and research approaches to improve the knowledge base of healthcare professionals and students and diagnostic and management procedures for pain. Several opportunities to enhance pain understanding, access, and management are also identified. 1. Introduction Despite recent advances in our understanding, diagnosis, and management of pain, several problems confront the pain field, especially in the case of chronic pain which remains a public health problem of epidemic proportion in most countries. This is largely due to the limited levels of (a) awareness of pain, particularly its socioeconomic impact and burden, and access to timely and appropriate care, (b) pain education, especially of health professionals, and (c) research into pain mechanisms and into ways to improve diagnostic and management approaches and healthcare delivery. This pain crisis has been highlighted over the past 2 decades by several authors and again recently by the recent report in the USA by the Institute of Medicine (IOM) [1–7]. This article will focus on these areas and provide for each some possible means to address the current crisis of chronic pain. 2. Awareness of Pain and Its Impact Pain is a subjective individual experience encompassing sensory, cognitive, emotional, and social dimensions. One person may report a moderate level of pain following an injury while another person with a similar injury may report a much higher, or lower, pain level. This individual-by-individual experience of pain depends on numerous features that include each person’s unique genetic features and cognitive, motivational, emotional, and psychological state as well as environmental factors stemming from their gender, past experiences and memories of pain, cultural and social influences, plus their general health condition. Pain does serve an important vital function as a warning signal of tissue damage, resulting from an accidental trauma, infection, or inflammation, for example. It usually disappears after the injured tissue has healed. In contrast to such acute pain episodes, chronic pain is usually considered as having no biological role but is associated with changes in the peripheral and central
References
[1]
H. Breivik, B. Collett, V. Ventafridda, R. Cohen, and D. Gallacher, “Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment,” European Journal of Pain, vol. 10, no. 4, pp. 287–333, 2006.
[2]
Institute of Medicine, “Relieving pain in America: a blueprint for transforming prevention, care, education, and research,” Report Brief, 2011.
[3]
J. D. Loeser, “Five crises in pain management,” Pain: Clinical Updates, vol. 20, no. 1, pp. 1–4, 2012.
[4]
D. Schopflocher, P. Taenzer, and R. Jovey, “The prevalence of chronic pain in Canada,” Pain Research & Management, vol. 16, pp. 445–450, 2011.
[5]
B. J. Sessle, “Outgoing president’s address: issues and initiatives in pain education, communication, and research,” in Proceedings of the 10th World Congress on Pain, Progress in Pain Research and Management,, J. O. Dostrovsky, D. B. Carr, and M. Koltzenburg, Eds., vol. 24, pp. 1–12, IASP Press, Seattle, Wash, USA, 2003.
[6]
B. J. Sessle, “Unrelieved pain: a crisis,” Pain Research & Management, vol. 16, pp. 416–420, 2011.
[7]
W. F. Stewart, J. A. Ricci, E. Chee, D. Morganstein, and R. Lipton, “Lost productive time and cost due to common pain conditions in the US workforce,” Journal of the American Medical Association, vol. 290, no. 18, pp. 2443–2454, 2003.
[8]
A. May, “Chronic pain may change the structure of the brain,” Pain, vol. 137, no. 1, pp. 7–15, 2008.
[9]
M. W. Salter, “Cellular neuroplasticity mechanisms mediating pain persistence,” Journal of Orofacial Pain, vol. 18, no. 4, pp. 318–324, 2004.
[10]
B. J. Sessle, “Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and their clinical correlates,” Critical Reviews in Oral Biology and Medicine, vol. 11, no. 1, pp. 57–91, 2000.
[11]
M. E. Lynch, F. Campbell, A. J. Clark et al., “A systematic review of the effect of waiting for treatment for chronic pain,” Pain, vol. 136, no. 1-2, pp. 97–116, 2008.
[12]
A. Boulanger, A. J. Clark, P. Squire, E. Cui, and G. L. A. Horbay, “Chronic pain in Canada: have we improved our management of chronic noncancer pain?” Pain Research and Management, vol. 12, no. 1, pp. 39–47, 2007.
[13]
D. E. Moulin, A. J. Clark, M. Speechley, and P. K. Morley-Forster, “Chronic pain in Canada—prevalence, treatment, impact and the role of opioid analgesia,” Pain Research and Management, vol. 7, no. 4, pp. 179–184, 2002.
[14]
M. L. Reitsma, J. E. Tranmer, D. M. Buchanan, and E. G. VanDenKerkhof, “The epidemiology of chronic pain in Canadian men and women between 1994 and 2007, results from the longitudinal component of the national population health survey,” Pain Research & Management, vol. 17, pp. 166–172, 2012.
[15]
J. L. Henry, “The need for knowledge translation in chronic pain,” Pain Research & Management, vol. 13, no. 6, pp. 465–476, 2008.
[16]
A. J. Koestler and A. Myers, Understanding Chronic Pain, University Press of Mississippi, Jackson, Miss, USA, 2002.
[17]
P. Lee, “The economic impact of musculoskeletal disorders,” Quality of Life Research, vol. 3, no. 1, pp. S85–S91, 1994.
[18]
C. J. Philips and D. Schopflocher, “The economics of pain,” in Health Policy Perspectives on Chronic Pain, P. Taenzer, S. Rashiq, and D. Schopflocher, Eds., pp. 41–50, Wiley-Blackwell, Weinheim, Germany, 2008.
[19]
M. J. Farrell, “Pain and aging,” American Pain Society Bulletin, vol. 10, pp. 8–12, 2000.
[20]
C. R. Green, “The healthcare bubble through the lens of pain research, practice, and policy: advice for the new president and congress,” Journal of Pain, vol. 9, no. 12, pp. 1071–1073, 2008.
[21]
R. Helme and S. Gibson, “Pain in older people,” in Epidemiology of Pain, I. K. Crombie, Ed., pp. 103–112, IASP Press, Seattle, Wash, USA, 1999.
[22]
M. Bond and H. Breivik, “Why pain control matters in a world full of killer diseases,” Pain: Clinical Updates, vol. 12, no. 4, pp. 1–4, 2004.
[23]
F. Brennan and M. J. Cousins, “Pain relief as a human right,” Pain: Clinical Updates, vol. 12, no. 5, pp. 1–4, 2004.
[24]
M. J. Cousins and M. E. Lynch, “The Declaration Montreal: access to pain management is a fundamental human right,” Pain, vol. 152, pp. 2673–2674, 2011.
[25]
P. Peng, M. Choiniere, D. Dion et al., “Challenges in accessing multidisciplinary pain treatment facilities in Canada,” Canadian Journal of Anesthesia, vol. 54, no. 12, pp. 977–984, 2007.
[26]
P. M？ntyselk？, E. Kumpusalo, R. Ahonen et al., “Pain as a reason to visit the doctor: a study in Finnish primary health care,” Pain, vol. 89, no. 2-3, pp. 175–180, 2001.
[27]
B. H. McCarberg, “Pain management in primary care: strategies to mitigate opioid misuse, abuse, and diversion,” Postgraduate Medicine, vol. 123, no. 2, pp. 119–130, 2011.
[28]
C. C. Upshur, R. S. Luckmann, and J. A. Savageau, “Primary care provider concerns about management of chronic pain in community clinic populations,” Journal of General Internal Medicine, vol. 21, no. 6, pp. 652–655, 2006.
[29]
M. Bond, “Pain education issues in developing countries and responses to them by the International Association for the Study of Pain,” Pain Research & Management, vol. 16, pp. 404–406, 2011.
[30]
A. C. Williams, “Chronic pain in survivors of torture,” Pain: Clinical Updates, vol. 15, pp. 1–6, 2009.
[31]
G. Varrassi, “Symposium on the Societal Impact of Pain 2011: European Commissioner John Dalli calls for a better understanding of ‘pain’in Europe,” Pain Management, vol. 1, no. 5, pp. 405–408, 2011.
[32]
P. Bouchard, “The Quebec experience,” in Chronic Pain: A Health Policy Perspective, S. Rashiq, D. Schopflocher, P. Taenzer, and E. Jonsson, Eds., pp. 291–301, Wiley-VCH, Weinheim, Germany, 2008.
[33]
P. Taenzer, “Chronic non-cancer pain in Canada: a public health perspective,” Report To Public Health Agency of Canada, 2008.
[34]
Royal College of Physicians and Surgeons of Canada, Specific Standards of Accreditation for Residency Programs in Pain Medicine, pp. 1–6, 2011.
[35]
W. Breitbart, “Pain in AIDS,” in Proceedings of the 8th World Congress on Pain, T. S. Jensen, J. A. Turner, and Z. Wiesenfeld-Hallin, Eds., vol. 8 of Progress in Pain Research and Management, pp. 63–100, IASP Press, Seattle, Wash, USA, 1997.
[36]
C. R. Green, J. R. C. Wheeler, and F. LaPorte, “Clinical decision making in pain management: contributions of physician and patient characteristics to variations in practice,” Journal of Pain, vol. 4, no. 1, pp. 29–39, 2003.
[37]
P. A. Pizzo and N. M. Clark, “Alleviating suffering 101—pain relief in the United States,” The New England Journal of Medicine, vol. 366, pp. 197–199, 2012.
[38]
J. Watt-Watson, J. Hunter, P. Pennefather et al., “An integrated undergraduate pain curriculum, based on IASP curricula, for six Health Science Faculties,” Pain, vol. 110, no. 1-2, pp. 140–148, 2004.
[39]
J. Watt-Watson, M. McGillion, J. Hunter et al., “A survey of prelicensure pain curricula in health science faculties in Canadian universities,” Pain Research and Management, vol. 14, no. 6, pp. 439–444, 2009.
[40]
S. Demyttenaere, G. A. Finley, C. C. Johnston, and P. J. McGrath, “Pain treatment thresholds in children after major surgery,” Clinical Journal of Pain, vol. 17, no. 2, pp. 173–177, 2001.
[41]
A. D. Furlan, R. Reardon, and C. Weppler, “Opioids for chronic noncancer pain: a new Canadian practice guideline,” Canadian Medical Association Journal, vol. 182, no. 9, pp. 923–930, 2010.
[42]
A. M. Gilson, D. E. Joranson, and M. A. Maurer, “Improving state pain policies: recent progress and continuing opportunities,” CA Cancer Journal for Clinicians, vol. 57, no. 6, pp. 341–353, 2007.
[43]
R. Stalnikowicz, R. Mahamid, S. Kaspi, and M. Brezis, “Undertreatment of acute pain in the emergency department: a challenge,” International Journal for Quality in Health Care, vol. 17, no. 2, pp. 173–176, 2005.
[44]
J. Watt-Watson, B. Stevens, P. Garfinkel, D. Streiner, and R. Gallop, “Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients,” Journal of Advanced Nursing, vol. 36, no. 4, pp. 535–545, 2001.
[45]
E. V. Briggs, E. C. J. Carr, and M. S. Whittaker, “Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom,” European Journal of Pain, vol. 15, pp. 789–795, 2011.
[46]
J. Hunter, J. Watt-Watson, M. McGillion et al., “An interfaculty pain curriculum: lessons learned from six years experience,” Pain, vol. 140, no. 1, pp. 74–86, 2008.
[47]
J. Watt-Watson, “Moving the pain education agenda forward: innovative models,” Pain Research & Management, vol. 16, p. 401, 2011.
[48]
B. B. Murinson, E. Nenortas, R. S. Mayer et al., “A new program in pain medicine for medical students: integrating core curriculum knowledge with emotional and reflective development,” Pain Medicine, vol. 12, no. 2, pp. 186–195, 2011.
[49]
N. Vadivelu, N. Kombo, and R. L. Hines, “The urgent need for pain management training,” Academic Medicine, vol. 84, no. 4, p. 408, 2009.
[50]
R. Chou, J. C. Ballantyne, G. J. Fanciullo, P. G. Fine, and C. Miaskowski, “Research gaps on use of opioids for chronic noncancer pain: findings from a review of the evidence for an American pain society and American academy of pain medicine clinical practice guideline,” Journal of Pain, vol. 10, no. 2, pp. 147–159, 2009.
[51]
D. H. Bradshaw, C. Empy, P. Davis, D. Lipschitz, Y. Nakamura, and C. R. Chapman, “Trends in funding for research on pain: a report on the national institutes of health grant awards over the years 2003 to 2007,” Journal of Pain, vol. 9, no. 12, pp. 1077–1087, 2008.
[52]
M. E. Lynch, D. Schopflocher, P. Taenzer, and C. Sinclair, “Research funding for pain in Canada,” Pain Research and Management, vol. 14, no. 2, pp. 113–115, 2009.
