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Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.
The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.
Cancer Pain Management, Second Edition will substantially advance pain education. The unique combination of authors -- an educator, a leading practitioner and administrator, and a research scientist -- provides comprehensive, authoritative coverage in addressing this important aspect of cancer care. The contributors, acknowledged experts in their areas, address a wide scope of issues. Educating health care providers to better assess and manage pain and improve patientsrsquo; and familiesrsquo; coping strategies are primary goals of this book. Developing research-based clinical guidelines and increasing funding for research is also covered. Ethical issues surrounding pain management and health policy implications are also explored.
With support from the Open Society Institute International Palliative Care Initiative, Human Rights Watch released a groundbreaking report on the lack of access to pain relief medicines for millions of patients worldwide. The report, "Please Don't Make Us Suffer Anymore": Access to Pain Treatment as a Human Right, finds that countries can significantly improve access to pain medications by addressing the causes of their poor availability, which include the following: *Failure to put in place functioning supply and distribution systems *Absence of government policies to ensure medicine availability *Insufficient instruction for health care workers *Excessively strict drug-control regulations *Fear of legal sanctions among healthcare workers. "Please Don't Make Us Suffer Anymore" notes that international law requires states to make narcotic drugs available for the treatment of pain while preventing abuse, but that the strong international focus on preventing abuse of such drugs has led many countries to neglect that obligation. The full report is available in PDF format. French, Russian, and Spanish versions are available on the HRW website.
All physicians are involved in the management of pain at some level or the other, but of the various specialties and health professions, surgeons are at the frontline of delivering perioperative pain care. Perioperative Pain Management for General and Plastic Surgery offers a concise yet comprehensive overview of the surgical pain management field to help practitioners effectively plan and enhance perioperative pain control. Chapters provide guidance on solving common dilemmas facing surgeons who are managing patients with pain related problems and clinical decision-making, and explore essential topics required for the trainee and practitioner to quickly assess the patient with pain, to diagnose pain and painful conditions, determine the feasibility and safety of surgical procedure needed, and arrange for advanced pain management consults and care if needed. This text also explores the latest evolving techniques and appropriate utilization of modern equipment and technology to safely provide care. Highly accessible and written by experts in the field, Perioperative Pain Management for General and Plastic Surgery is an ideal resource for practicing surgeons, anesthesiologists, critical care personnel, residents, medical students.
This text covers the fundamentals of pain, the pharmacology of drugs used, and summarises the current evidence base for the management of acute pain. It provides practical direct clinical applications and strategies for the management of specific medical conditions in patient groups such as the elderly
This is a revised and expanded edtion of a classic in palliative medicine, originally published in 1991. With three added chapters and a new preface summarizing our progress in the area of pain management, this is a must-hve for those in palliative medicine and hospice care. The obligation of physicians to relieve human suffering stretches back into antiquity. But what exactly, is suffering? One patient with metastic cancer of the stomach, from which he knew he would shortly die, said he was not suffering. Another, someone who had been operated on for a mior problem--in little pain and not seemingly distressed--said that even coming into the hospital had been a source of pain and not suffering. With such varied responses to the problem of suffering, inevitable questions arise. Is it the doctor's responsibility to treat the disease or the patient? And what is the relationship between suffering and the goals of medicine? According to Dr. Eric Cassell, these are crucial questions, but unfortunately, have remained only queries void of adequate solutions. It is time for the sick person, Cassell believes, to be not merely an important concern for physicians but the central focus of medicine. With this in mind, Cassell argues for an understanding of what changes should be made in order to successfully treat the sick while alleviating suffering, and how to actually go about making these changes with the methods and training techniques firmly rooted in the doctor's relationship with the patient. Dr. Cassell offers an incisive critique of the approach of modern medicine. Drawing on a number of evocative patient narratives, he writes that the goal of medicine must be to treat an individual's suffering, and not just the disease. In addition, Cassell's thoughtful and incisive argument will appeal to psychologists and psychiatrists interested in the nature of pain and suffering.