"A Call to Revolutionize Chronic Pain Care in America"

(But hang up after one ring)

The Mayday Foundation has a long credibility in Pain Management. For over 20 years it has been s significant voice and funding source in approaching pain management policy. The November 4, 2009 publication of the recommendations of a Special Committee, convened by the Foundation to address the continuing suffering of millions of adults and children, is an example of its commitments. The Recommendations provide very useful background information and policy suggestions.

Unarguably the situation for acute and chronic pain patients is currently horrific, and the report clearly documents the situation. Further, pain care should be coordinated, beginning with primary care providers, disparities should be eliminated, unnecessary and ineffective invasive procedures and medication treatments should also be eliminated, and effective, comprehensive treatment should be universally available and implemented.



Further, federal and state agencies, state medical boards, health care payors and providers, medical schools, specialty and subspecialty organizations and all other "stakeholders" should be enlisted in achieving the goals of universal pain care available to all. And specifically the HRSA, HHS, NIH, AHRQ, the Surgeon General, health care providers, insurers and government should work to eliminate disparities in access to pain care related to race, ethnicity, gender, age and socioeconomic status; and federal, state and local agencies should adopt a balanced approach to the regulation of controlled prescription drugs, particularly opioids



Specifically, the report calls for:

· government, health care payers and health care providers should develop and use coordinated health information technology systems to track pain disorders, treatments and outcomes to improve care;

· physicians should be trained to assess and treat pain, and licensing examinations should include assessment of clinical knowledge related to pain care;

· the Health Resources and Services Administration should expand funding for training programs that address pain assessment and management;

· HHS should establish an independent commission to reform the reimbursement practices for chronic pain treatment;

· the NIH should increase funding for pain research;

· the Agency for Healthcare Research and Quality should expand funding to establish a set of best practices that could be used to treat specific types of chronic pain;

· the U.S. surgeon general should create a public education campaign about the risks of untreated and undertreated pain

However, amazingly, what the Committee did not mention was the "War on Doctors' - that horrific campaign that has destroyed the careers (and even the lives) of so many decent,

dedicated and caring physicians, and left thousands upon thousands of chronic pain patients in an abyss of abandonment and professional and regulatory indifference.

Also, conspicuous in its absence, was any mention of the single largest obstacle to adequate pain care - "Opiophobia".

Perhaps the members of the Special Committee believed that their studiously polite diplomacy required that these topics not be mentioned, as education and collegiality would cause them to dissipate before a wave of enlightenment. Perhaps they believed that it was best not "to kick the sleeping dog" - that confrontation would be best avoided in favor of education and the confluence of policy.

We have no way of knowing the Committee's motivations in this regard. However, it is safe to assume that opiophobia will disappear no more quickly than did racism. History makes it abundantly clear that a Chamberlain approach to brutality will accomplish little but self-delusion.

Sad to say, but I predict that collegial policy thumping will have no impact on the destructive mythologies and pharmacological shibboleths that characterize opiophobia. The myths of addiction, tolerance, toxicity, criminality, abuse, diversion are deeply engrained in the professional mindset of opiophobic physicians and the medical Boards upon which they sit. We have already seen in the examples of the "Model Intractable Pain Policy" adopted by the Federation of State Medical Boards in 2003, the "Pain as the Fifth Vital Sign" initiative of the Joint Commission on Accreditation of Health care Organizations in 2001, and the Pain Initiative of the Veterans Administration, that noble pronouncements are completely disconnected from the realities of the day to day priorities and actions of these boards. Everyone already knows the information summarized by the Mayday Committee. It has been part of the Zeitgeist since Dr. Pappagallo's news releases in 1996.

What is needed now is not polite policy but hard-nosed mandates. Whether it is to be federal legislation, state regulations, or a federal lawsuit, the opiophobes must be removed. Politeness and diplomacy will go nowhere (again). So thanks, Mayday, and the "Special Committee". Your intentions are noble. But one of the things that made the Committee "Special" is that there wasn't a single person sitting on it who's life and career is on the line every time they write a schedule II prescription. It's easy to be polite and diplomatic when no one is sticking a gun in your mouth.

I have to agree with Siobhan. Talk, talk, talk.

Joel Simon Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
www.paincare.org