Vision of Optimal Pain Management
The individual suffering with chronic pain
Individuals suffering with acute pain by the numbers
Number of Americans in this group:
Total costs for healthcare services for each person in this group:
$800 per year
Total healthcare costs for this group per year:
A recent Institute of Medicine report estimated the annual cost in the United States was $560 to over $600 billion, including healthcare costs ($261-300 billion) and lost productivity ($297-336 billion).3
The healthcare goals for people in this group
Staying alive, optimal function, healthy and flourishing
Individuals suffering with acute pain
Ms. Smith, a 53-year-old female, suffering with chronic pain associated with a MVA. She has had a number of hospitalization for suicdal thoughts and one suicde attempt.
By September 2020, every individual who experiences pain has access to and is able to receive evidence based, best practice informed treatment that improves their wellbeing in outcomes that matter for them.
The healthcare concerns of the individual suffering with acute pain
Autonomy, rehabilitation, limiting progression, accommodating environment, caregiver support
Major Components of Medical and Health Care
Acute care- Urgent care, ER, Integrated Pain management
Goals for Health Care
Living with chronic pain
Optimal care for individual suffering with chronic pain
Basic cost for health care services, treatments and support services are covered fully. In addition where appropriate lifestyle related interventions, screening and prevention activity are also covered. The cost of acute hospitalization, nursing facility care, long term care, where medically indicated is covered.
The coverage is universal and not dependent on the condition, stage of life or ability to pay. Supplemental insurance may be purchased. Plans may compete of riders for additional services. Employers may also provide additional services. Coverage for education of caregivers will be provided.
Preferably the person who is chronically ill will have a primary care doctor or if indicated a specialist who will coordinate their care. Specialists will be available for consultation in person or through other means to address specific problems. The person will have choice of providers including doctors, hospital, nursing facility, local pharmacy, or certified health club. Emergency Medical Services that can provide immediate care and transfer to appropriate level of care. Home evaluation and treatment available promptly; 24/7 rapid response to home for crises Equal access to health care services tailored to situation. Administrative needs are minimal.
Quality Health Care:
Patient Centered (No Helplessness or Unjustified Routines): Care is patient centric and is provided with dignity, cultural sensitivity and respect for the person. Information is provided in age and education level appropriate manner. Advance care planning consistent with patient’s wishes; resolution of family issues; support of family caregivers. Informed and shared decisions reflecting parents’ values (constrained by legal limits). Lifestyle reflecting informed decisions; self-monitored care; patient and family education.
Safe (No Harm): Care that is provided will be safe from errors. This will be of particular challenge when there are changes in the venue of care. For example the person is in need of hospitalization and the medications they take are not given as ordered.
Effective (No Needless Failures): Specific outcomes will be measures and adjustment in the services made. Recommendations from national agencies and groups will be followed. Care that is effective for the problems experienced by the person suffering with a chronic condition. Evidence-based secondary and primary prevention and rehabilitation. Government and professional association guidelines are readily available and are transparent. Home-based care; nutritional support; reliable facility care when needed; support for caregivers; appropriate preventive services.
Efficient (No Waste): For brief acute episodes, diagnosis is made and care provided in timely efficient manner. A treatment plan is formulated according to an informed dialogue with the person or their legal representatives. Government and professional association guidelines are readily available and are transparent. Regulatory agencies oversee quality of services, and advertising to consumers.
Timely (No Needless Delays): Evaluation and treatment for brief acute episode is available promptly. Convenient and responsive scheduling, no waiting for health care services; immediate access to results of tests; immediate access to clinical guidance and other information; timely education and support; Little waiting for health care services; adequate notice of expected events; convenient and responsive scheduling; immediate access to test results, clinical guidance, and other information; short time to diagnosis and treatment for positive screens and worsening conditions.
Equitable (No Unjustified Variation): Care is provided universally with no bias due to personal characteristics. equal opportunity for important treatments; no bias due to personal characteristics. Regulatory agencies oversee quality of services, and advertising to consumers.
Coordination of Care:
Care is patient centric and revolves around the patient and their doctor (clinician). Care continuum management across multiple providers. Public health services that have provisions for early identification of community trends. Education regarding risk factors and practical ways to avoid them. For identified problem and secondary prevention, care is coordinated regionally, through medical records, supported by privacy provisions. Care in its various levels is coordinated to achieve best outcomes and limit errors and cost. For identified problem and secondary prevention, care is coordinated regionally, through medical records, supported by privacy provisions. Public health provisions for early identification of community trends.
The goal of innovation is to improve quality of the person thorough achieving and maintaining optimal function. Personalized medicine, identified early susceptibility based on genetics, technological tools to assure compliance with treatments and ability to monitor response to interventions. Utilization of personal medical records that can automatically provide reminders of needed screening, immunizations and monitoring response. A personal record of treatments for acute episodes including medications and side effects that is paper or electronic based. It would include new treatments, diagnostic procedures, new services, new monitoring tools new delivery systems and concepts. Updates on research and innovation quickly reaching the point of care and the person who will benefit from it.
Computerized physician order entry with decision support
Pain management that is patient specific
Digital enhanced educational content
Apps to support recovery and early recognition of side effects
Information and transparency for decision making about treatment options
Monitoring devices for opioid overdose
Electronically available health care plans
Advance care plans available
Electronically 24/7 access
Secure message capability
Available in language and level of education of choice
Real-time home monitoring devices; e-reminders for screens and monitoring
Longitudinal electronic health records and personal health records
Pain is a multidimensional problem ranging from discomfort to agony and affecting physical, emotional, and cognitive function as well as interpersonal relationships and social roles.
In this section you will learn more about pain, its causes and learn of our vision for optimal evaluation and treatment of acute and chronic pain:
1. Overview of pain
2. Causes of pain
3. Evaluation of pain
4. Treatment for pain
5. Resources for optimal choice
The burden of dealing with unremitting pain can be devastating to a patient's psychological well-being and can negatively affect their ability to maintain gainful employment or achieve meaningful professional advancement. It can affect relationships with spouses and significant others; may limit engagement with friends and other social activities; and may induce fear, demoralization, anxiety, and depression.
Ecosystem and Stakeholders
Guidelines and Best Practice
Pain management across the life course
The Pain Module
Cancer related pain
The Pain Treatment Checklist
Monitoring Pain and its Treatment
Content will be in various forms including articles, infographs, interviews, links to other websites, video and other media forms.
Local: Healthcare providers
National: Healthcare providers
Approach to Back Pain : Functional restoration uses exercise and psychological therapy to get patients over fear and back to normal life
Buprenorphine patches are used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. It is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.
About pain and its treatment
Every clinician desires to provide quality pain management for their patients. Every patient with pain would like to receive quality pain care. What does “good pain care” look like? The Departments of Veterans Affairs and Defense have been working to develop and implement a common operational picture for the type of pain care they are building within their respective health systems. This video provides an overview of the Six Essentials of Good Pain Care.