NLM Director’s Comments Transcript
Pain Relief: 02/21/2012

Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

The cost and number of Americans who suffer from pain are overlooked — and require innovative efforts to improve education for health care providers as well as the public, finds an editorial recently published in the New England Journal of Medicine.
The editorial’s authors, who co-chaired the Institute of Medicine (IOM’s) recent report on pain, begin by writing (and we quote): ‘the magnitude of pain in the United States is astonishing’ (end of quote).
The authors explain the IOM report finds 116 million Americans have pain that persists for weeks to years. The IOM report estimates the total cost of managing pain is from $560 to $635 billion annually. The authors note these estimates do not include pain in children, adults in long-term care facilities, persons in the military, or prison.
The authors memorably write (and we quote): ‘the annual U.S. expenditures related to pain (including direct medical costs and lost wages) are higher than those for cancer, heart disease, and diabetes combined’ (end of quote).

Philip Pizzo M.D. and Noreen Clark Ph.D., from Stanford University School of Medicine and the University of Michigan respectively, add the IOM report concludes addressing acute and chronic pain is a significant, overlooked medical, social, and cultural problem in the U.S.
A website from American Academy of Family Physicians (available in the ‘start here’ section of MedlinePlus.gov’s pain health topic page) explains acute pain lasts a short time, or is expected to be resolved soon. Chronic pain lasts beyond the healing of an injury, continues for several months or longer, or occurs frequently for months.
The editorial’s authors find a cultural transformation is needed to change the way clinicians and the public view pain and its treatment. Currently, the authors explain patients with pain often experience denial, avoid care, have problems explaining their level of pain to health care providers, or find physicians to be poor listeners.
In response, the authors suggest (and we quote): ‘change must begin with education of the person who is in pain – and the recognition that a person’s beliefs about pain (including concerns about discussing it with clinicians) can substantially affect outcome’ (end of quote).
Among other remedies suggested by the authors are:

expand pain management education for medical students and practicing physicians regardless of specialty area
restructure reimbursement so primary care physicians can spend more time with patients with chronic pain
recognize that pain treatment is more than a clinician’s intervention and includes the ability of providers, patients, caregivers, and family members to work together
create innovative public education efforts to counter myths, stereotypes, and stigmas associated with pain.

The authors note the IOM report is a blueprint to transform prevention, care, education, and research to relieve pain. Their editorial suggests there is some urgency for progress.
Meanwhile, the aforementioned website provided by the American Academy of Physicians (within the ‘start here’ section of MedlinePlus.gov’s pain health topic page) helps you talk to health care providers about pain. A quality of life scale that helps you specify and explain your pain level (from the American Chronic Pain Association) is available in the ‘disease management’ section of MedlinePlus.gov’s pain health topic page.
MedlinePlus.gov’s pain health topic page also contains sections on: diagnosis/symptoms, treatment, rehabilitation/recovery, and coping.
To keep up with the issues raised by the editorial, MedlinePlus.gov’s pain health topic page contains updated research summaries, which are available within the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the pain health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.
To find MedlinePlus.gov’s pain health topic page, type ‘pain’ in the search box on MedlinePlus.gov’s home page, then, click on ‘pain (National Library of Medicine).’
Other related health topic pages within MedlinePlus.gov include: abdominal pain, back pain, pelvic pain, and chest pain. We also recommend MedlinePlus.gov’s pain relievers health topic page.
It surprised us the New England Journal of Medicine’s editorial avows a topic as fundamental as pain is often overlooked. Let’s hope the IOM report gains some traction and is linked to related IOM activities, such as enhancing the American public’s health literacy.
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A disclaimer – the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider. I want to take the opportunity to wish you a very happy holiday season and a healthy New Year. The National Library of Medicine and the 'Director's Comments' podcast staff, including Dr. Lindberg, appreciate your interest and company – and we hope to find new ways to serve you in 2012.
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