Expand & Enhance Chronic Pain Prevention & Management

Return to the  Zoom Map (Reduce Prescription of Opioids)

Background

• Chronic pain occurs when pain last for longer than 3 months.
• Pain affects more Americans than diabetes, heart disease and cancer combined.
• 25.3 million American adults suffer from daily pain.
• 23.4 million American adults report a lot of pain.
• 14.4 million American adults suffer the highest level of pain, category 4.
• Today, chronic pain is the most common cause of long-term disability in the U.S.

Chronic Pain and Opioid Use Among Seniors

Chronic pain is the primary reason seniors are prescribe opioids -- and use of opioids has many negatives for seniors (great article)

Risk factors

for chronic pain include:

 

• genetics - heritability accounts for 38.4% of the variation in chronic pain risk
• female gender
• older age
• race and ethnicity
• being a military veteran
• low socioeconomic status
• employment status and occupational factors
• history of abuse or interpersonal violence
• anxiety and depression
• existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system
• lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem
• previous surgery

 

Managing Chronic Pain

• 8 Million Americans are on long-term opioid therapy for chronic pain
• 1 million are taking dangerously high doses
• The dilemma: how to provide the most effective pain treatment for 80 percent of pain patients who are at least risk for opioid addiction while causing the least harm to the remaining 20 percent who are at most risk of developing OUD
• Experts say chronic pain sufferers on high doses aren’t necessarily addicts, at least not the sort who would resort to buying drugs on the street
• With most medical and government resources focused on treatment for more obvious drug abusers, few formal programs exist to help patients dependent on opioids
• Experts who have studied opioid dependence say that, in some cases, it’s too risky to reduce doses until complex psychological problems are under control

Current Status

Expanding and improving pain prevention programs is a hot topic among public health officials. In March 2016, the National Institute of Health released its National Pain Strategy that outlines the federal government's first coordinated plan to address America's pain crisis. One of the cornerstones of the strategy is prevention of chronic pain.
 

 

Promising Programs

Avoiding Illness and Injury

Workplace injury and illness prevention programs at both establishment and corporate levels are effective in transforming workplace culture; leading to reductions in injuries, illnesses and fatalities and lowering workers' compensation and other costs.
 

Educational Programs

• Back Pain - Don't Take It Lying Down (Australia) - a 3 year campaign in Australia in the late 1990s that used mass media and other methods to promote several evidence-based concepts about back pain.
  • Outcome: "Dramatic improvements in what the public and clinicians believed about back pain, accompanied by a decline in related workers’ compensation claims and health care utilization during the campaign; those beliefs have persisted over time."

 

Behavior Change Programs

[need examples]
 

Pain Self Management Programs

myStrength is an example of a promising pain management program.
 

Private Facebook Group

Clare Rhodes runs a private Facebook group for chronic pain patients.
 

The DiscovEHR Project

A researcher from Florida Atlantic University's Charles E. Schmidt College of Medicine has received a five-year, $4 million grant from the National Institutes of Health to help solve the "one-size-fits-all" approach to prescribing opioids for chronic pain. Because of the high heritability, finding the genetic predictors of prescription opioid use disorder is more critical than ever. Currently, little data exists on clinical characteristics and genetic variants that confer risk for opioid use disorder.

In the novel study, researchers will assess clinical and genetic characteristics of a large patient cohort suffering from chronic musculoskeletal pain and receiving prescription opioids. As part of the project, researchers will leverage data from Geisinger's central biorepository and electronic health record (EHR) database to conduct large-scale genomics research and phenotype development.

With the genetic information, the multidisciplinary team will derive a clinical and genetic profile of prescription opioid-use disorder and apply the knowledge to develop an "addiction risk score." Researchers hope the findings from this study will enable clinicians to identify those who are at low-risk for opioid use disorder from those who are at high-risk and require additional counseling and access to alternative treatment options.

The genome-wide association study will help the researchers determine if there is a particular subset of genes and genetic variants that are influencing susceptibility to becoming addicted to prescription opioids. Once they are able to generate the hypothesis that a genetic variant is responsible for increasing risk, the next steps will involve proving causation. Ultimately, the researchers hope their work will be used to help empower patients so that they understand their susceptibility to risks and can make informed health care decisions.
 

Tools & Resources

TR - Expand & Enhance Chronic Pain Prevention

Scorecard Building

Potential Objective Details (Under Construction)
Potential Measures and Data Sources (Under Construction)
Potential Actions and Partners (Under Construction)

Resources to Investigate

RTI Expand & Enhance Chronic Pain Prevention

PAGE MANAGER: [insert name here]
SUBJECT MATTER EXPERT: [fill out table below]

Reviewer	Date	Comments

 

Sources

 

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1. [1]
2. "Pain Management." National Institutes of Health. U.S. Department of Health and Human Services, 29 Mar. 2013. Web. 27 Jan. 2017. <[2]>.
3. Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017.
4. Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017.
5. Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017.
6. "Pain Management." National Institutes of Health. U.S. Department of Health and Human Services, 29 Mar. 2013. Web. 27 Jan. 2017. <[3]>.
7. PLOS. "Genetic and environmental risk factors for chronic pain." ScienceDaily. ScienceDaily, 16 August 2016. <www.sciencedaily.com/releases/2016/08/160816151850.htm>.
8. O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
9. O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
10. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. 2, Pain as a Public Health Challenge.Available from: [4]
11. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. 2, Pain as a Public Health Challenge.Available from: [5]
12. O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
13. O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
14. O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
15. O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123
16. "Chronic Pain - What Increases Your Risk." WebMD. WebMD, n.d. Web. 27 Jan. 2017. <[6]>.
17. "Chronic Pain - What Increases Your Risk." WebMD. WebMD, n.d. Web. 27 Jan. 2017. <[7]>.
18. McGreevy, Kai, Michael M. Bottros, and Srinivasa N. Raja. “Preventing Chronic Pain Following Acute Pain: Risk Factors, Preventive Strategies, and Their Efficacy.” European journal of pain supplements 5.2 (2011): 365–372. PMC. Web. 27 Jan. 2017.
19. [8]
20. [9]
21. #******** [10]
22. [11]
23. [12]
24. [13]
25. "National Pain Strategy." National Institutes of Health. U.S. Department of Health and Human Services, 18 Mar. 2016. Web. 27 Jan. 2017. <[14]>.
26. [15]
27.  

Alsop and LeCouteur, 1999; Bunn et al., 2001; Conference Board, 2003; Huang et al., 2009; Lewchuk, Robb, and Walters, 1996; Smitha et al., 2001; Torp et al., 2000; Yassi, 1998 as cited in "Injury and Illness Prevention Programs - Frequently Asked Questions." Injury and Illness Prevention Programs - Frequently Asked Questions. U.S. Department of Labor - Occupational Safety and Health Administration, Jan. 2012. Web. 31 Jan. 2017. <[16]>.

• Buchbinder R. Can we change a population’s perspective on pain? In: Croft P, Blyth FM, van der Windt D, editors. Chronic pain epidemiology: From aetiology to public health. Oxford, England: Oxford University Press; 2010. pp. 329–344.
• Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. 2, Pain as a Public Health Challenge.Available from: [17]
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[18]

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[19]