Innovations In Clinical Neuroscience

Hot Topics in Pain Management October 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Hot Topics in Pain Management [October 2017] 13 R E V I E W The Management of Chronic Pain—Caught Between a Rock and a Hard Place: The Case for a Renewed Focus on Provider, Patient, and Payer Education by Talal W. Khan 1 and Farnad Imani 2 1. Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, United States 2. Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran THE BURDEN OF CHRONIC PAIN Chronic pain is a significant public health burden. This affliction affects at least 10 percent of the world's population with an additional 10 percent developing various forms of debilitating chronic pain every year. 1 The 2010 Global Burden of Disease report places back pain as the leading cause of years lost to disability. 2 Upon further review of this report, it becomes apparent that eight of the top 12 conditions responsible for global disability, which include low back pain, neck pain, arthritis, other musculoskeletal conditions, migraines, anxiety, depression, and drug use disorder, are conditions associated with chronic pain. The Department of Health and Human Services (HHS), National Institutes of Health (NIH), requested the Institute of Medicine (IOM) to address the current state of pain research, care, and education and to explore and make recommendations for the advancement of the science related to the field. The IOM report released in 2011 estimates that approximately 100 million people suffer from chronic pain. 3 Admittedly, the number of people actively seeking care for this complex disease does not reach 100 million. However, many people live with the burden of chronic pain, which might wax or wane during their lifetimes. According to various estimates, 20 to 30 million individuals experience chronic pain to such a degree that it erodes quality of life and the ability to work, while forcing them to actively seek care for this condition. Access to providers with the skills necessary for appropriate evaluation and management of pain is limited. The majority of sufferers seek care with their primary care providers, many of whom are primarily in a rural setting in the state of Kansas. These providers often lack the additional resources needed for the appropriate evaluation and management of chronic pain patients presenting with complex behavioral manifestations and functional limitations. Without the proper care, patients are unable to break out of the vicious cycle of increasing pain, limited function, and generalized deconditioning. CENTERS FOR DISEASE CONTROL (CDC) GUIDELINES FOR THE PRESCRIPTION OF OPIOIDS FOR PERSISTENT NON-CANCER PAIN Juxtaposed against this scourge of pain is the epidemic of opioid abuse. Deaths related to the abuse of prescription and Anesth Pain Med. 2017;7(1):e40951. Published online 2016 Dec 3. doi: 10.5812/ aapm.40951 FINANCIAL DISCLOSURE: The authors have no financial interests related to the material in the manuscript. RECEIVED: 8 Aug 2016; ACCEPTED: 12 Sept 2016; PUBLISHED: 3 Dec 2016 COPYRIGHT: © 2017, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creative- commons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. AUTHOR INFORMATION: Talal W. Khan, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, Kansas, 66260. Phone: +98-9135883315, Fax: +98-9135883365, E-mail: tkhan@kumc.edu. KEY WORDS: Chronic pain, healthcare, quality of life, pain assessment, pain man- agement, opioids, opioid addiction, medi- cation compliance, alternative pain therapy, public education, provider education, rural health care, national pain strategy, compre- hensive care

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