Friday, April 3, 2015

Make a Public Comment on the National Pain Strategy by Celeste Cooper

The National Pain Strategy is out. 
You can view it and download it here

Public comments on the draft National Pain Strategy must be received no later than 5 p.m. EST on May 20, 2015. Written comments sent electronically are preferred and may be addressed to

Following is mine.

To whom it may concern:

I agree that collaboration between primary and pain specialists is helpful in some cases, though I do not believe it is mandatory, and this is why.

  • Many pain specialists are only interested in interventional care.
  • Monthly visits for the pain patient who uses a non-escalated dose of opioids over a period of years, for instance, is time consuming and costly to the patient and society.
  • Forcing patients into a chronic pain program that have not had any red flags, are not a safety risk, could create perceived stigma where there was none.
  • To think that a primary physician cannot complete continuing education courses for management of mild to moderate chronic pain is ridiculous.
  • Primary physicians are on the front lines. They will be held accountable for prevention strategies, but they aren’t able to make assessments for treating pain? This seems like tying their hands behind their backs. Board certified family physicians should not be segregated from treating uncomplicated chronic pain independently. Who is better trained in meeting the biopsychosocial needs of a patient?
  • Certainly, complicated chronic pain should be under the supervision of a pain specialist, however not all patients meet this criteria, and not all pain specialists take a biopsychosocial approach. It would be interesting to have the data on this and I am grateful you are doing just that.

What I like as an RN and a Chronic Pain Patient

  • Core competency in treating complicated chronic pain.
  • Addressing the stigma of chronic pain.
  • A biopsychosocial model.
  • Collecting data that will improve outcome based treatment.
  • Recognition of the need for programs that address patients as a whole.
  • Studying chronic pain as a disease.
  • Advocating for complimentary treatments that work, with the goal of making them accessible to all patient regardless of ability to pay.

Playing Devil’s Advocate

Standardizing electronic records in a free corporate society may not be possible. This should have been planned out before it was ever initiated. I have physician family members who tell me EMRs will not be practical as long as there are so many different computer programs.

Have you ever taken any of the alternative drugs offered? Why aren’t we equally concerned about the abuse of drugs like Neurontin® or Lyrica®? There was not one mention of these drugs in this report. Isn’t focusing only on opioids stigmatizing?

Will all insurance companies be willing to pay for integrative treatments? If not, which is most likely, doesn’t this mean those of us without deep pockets will not be able to afford the complimentary care our physicians expect? It is difficult to get Medicare to pay for TENS units and supplies. But they will pay for interventional procedures, some that are costly to society and have not been proven to bring any lasting effects. How can we curtail spending if we put all pain care in the hands of already overloaded pain specialists?

How can we force private practice pain physicians to adhere to and develop a clinic that takes a biopsychosocial approach to treatment? Is this not a violation of free enterprise of our nation? Not that I don’t agree this is the right approach, but in practicum, is it possible?

How are we to stop the stigma associated with chronic pain if opioids are seen as bad? The patient’s who benefit from opioids, that do not require escalated doses of many years, and do not tolerate alternative drugs, like myself, are not identified in the data. Without this data, won’t chronic pain always have an associated stigma? The last data I saw was that 70% of patients using opioids would not abuse their medications. Can we expect future data on this?

How many overdoses occur from under-treatment of pain? Can we expect a comparative analysis? Why is opioid treatment for chronic pain left out of the conundrum of opioid statement? Isn’t this stigmatizing?

Despite best efforts, chronic pain will exist. When the patient does approach their pain in a biopsychosocial way (I write books on this and practice it), and their pain persists, will they feel inadequate, isolated, and depressed, all the things a multimodal approach is supposed to fix?


Looking at chronic pain as a public health issue is the right approach in my opinion. It will avail resources that wouldn't otherwise be accessible. The report is comprehensive, there will be roadblocks in implementing all the suggestions, but hopefully generations to come will benefit. As an educator, I was impressed on seeing short-term to long-term goals. This strategy provides a mechanism for reassessment and revision.

Chronic pain devastates the lives of people living with it. Patients did not ask to have injury, anatomical defects, or disease processes that create the chronic pain web of deceit. Acceptance is necessary for forward momentum, and that doesn't include just the patient, it also includes their provider, their families, their employers (if they are lucky enough to have one), their friends, and society in general.

Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog
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"Adversity is only an obstacle if we fail to see opportunity."  
Celeste Cooper, RN
Author—Patient—Health Central Chronic Pain ProAdvocate—Sharecare Fibromyalgia Health Expert


All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  


pain care improvement said...

Healthy minded bias and Rockwellesque abound in the health care industry-despite the many failure of medicie to improve quality or even wash their hands between patient visits. But the simple facts are the prevalence of pain is rapidly on the rise-and medicine doesnt even care to have a plan to address that. The NPS is just a thinly veiled occupational strategy with no clear goals. FOr example it calls for "reducing bias" in pain care- no mention of how much reduction we can expect. It doesnt call for mandating any doctor to have any education in pain care. THe biopsychosocial model they promote is underresearched and unproven.
Its unfortunate that once again Casey at the bat has strck out= modern medicine has failed to develop an energetic or convincing plan to substantially improve pain care- but since when did medicine care about peoples pain?

The Pained Ink Slayer said...

The Pain Action Alliance to Implement a National Strategy is speaking up through cooperation with the NIH and other important government agencies to change the way pain is perceived, judged and treated. I hope you will take a moment to see what's happening. Be sure to read the policy briefs too. This initiative is from the Center for Practical Bioethics. Myra Christopher sat on the IOM committee that drafted "Relieving Pain in America" and she is a dear friend. Never doubt people, including physicians, are working hard to change pain care in America.

pain care improvement said...

Not everyone "sees like a state"- your friends in the CPATF and AAPM, APS have failed ot consider the role of multimorbidty in pain care- which especially effects many elderly. Dr. Terman indicated he was disappointed about the NPS with regard to pediatric pain. No real evidence of knowledge of implementation science in the NPS.
Its regrettable that the NPS fails to reflect much in the way of what needs to be done to make pain care adequate. The fact that the NPS has no rela measurables, no proce tag- makes it one rough beast- and i say no one should buy a pig in apoke. MS Cooper who could deny that your community of practice are really the ones who will benefit from the NPS. And its unfortunate your colleagues intentionally left out the millions of Americans who are concerned about their own pain care.
When i write to your colleagues- they refuse to enegage in a dialogue- and no doubt, the same process will happen to those in pain when they want to dialogue wit their provider. The NPS will spread their careless managerialism onto people in pain ad further silence anyone in pain from being hears Prove me wrong Ms Copper- gather your colleageus and lets debate it openly in public- Ive been watching Dr Oz religiously and taking my whey powder- my dorsolateral prefrontal cortex is well methylated- and my mitochondrial criste density is real good.......

The Pained Ink Slayer said...

EDSinfo. You are not alone in your comments. You may be interested to know that your concerns were addressed in a telephone conference between PAINS and our patient leladership group. Everyone who units wants measurable, evidence based tools for assessing chronic pain, patient outcome, and delivery of care. The NPS is just a start. They are taking comments from the community under advisement. I hope you sent your in. As with anything, building a tool is just the beginning. There is no doubt it will take many revisions for many years, but it is a start. There are advocates from the groups you mention that have already began thoughts and ideas as to how such a strategy will be funded and graded for its efficacy. You can view the many groups who are collaborating their efforts at SPPAN, the US Pain Foundation The American Chronic Pain Association PAINS and more which you can view links on my website under advoate
I am but one, but I am gifted by knowing those who invest their time and commit themselves to making this a better world for those of us who live with chronic pain.

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