Outlook | Newsletter of the Society of Behavioral Medicine

Pain SIG Update

Martin D. Cheatle, PhD, Pain SIG Chair

"Unity is strength… when there is teamwork and collaboration, wonderful things can be achieved" (Mattie Stepanek)

Woman in pain As active members of the Society for Behavioral Medicine we share a common vision, but we often work in silos. The gift of being a member of SBM is the opportunity to network and build collaborations across disciplines and interests. The mission statement of the Pain SIG is to "advance the understanding of pain and its treatment according to a biopsychosocial framework." We aim to achieve this mission by increasing interdisciplinary communication and collaboration with other SBM SIGs.

Chronic pain has become a significant healthcare problem and a public health crisis. More than 50 million Americans suffer from chronic or recurrent pain (1, 2). The prevalence of pain in the cancer population is also noteworthy. Greater than 60% of patients with metastatic or advanced diseases, 59% of patients receiving cancer treatments, and 33% of cancer survivors experience pain, and more than a third of these patients rate their pain as moderate to severe (3). Chronic pain can impact quality of life and work productivity. The societal costs of chronic pain are also high: the annual costs of medical diagnostics and treatment, compensation for lost wages, and lost productivity has been estimated at more than 200 billion dollars per year (4, 5).

The study of pain mechanisms and psychosocial processes has applications in a variety of clinical and research settings. For example, there have been meaningful developments in psychosocial and pharmacologic interventions for managing cancer-related pain and at end of life. Complicated pain patients are best treated in an integrated interdisciplinary pain program. However, the vast majority of these patients are cared for in the primary care setting where practitioners have a paucity of time, training, and resources to effectively evaluate and manage these complex pain cases. These resource constraints can lead to additional suffering and costly complications.

Developing evidence-based, effective, and cost and time efficient interventions that reduce pain, improve mood and function while decreasing health care expenditures would significantly relieve the burden of pain on the individual pain sufferer and society. Although there is evidence that physical and behavioral interventions improve pain and function, there is a need for more rigorous interdisciplinary research. Systematic reviews have demonstrated a benefit of exercise in improving disability in the pain population but the overall results have been modest (6). There is an opportunity to investigate issues of adherence and which exercise type is best suited for a particular pain disorder in order to maximize treatment response (7). Likewise, psychological interventions have merit but require additional work such as matching specific patient characteristics to treatment type (8). Both physical and psychological interventions would gain from the translational research, for example, of pain sensitivity and gender response differences (9).

There are numerous opportunities for cross-SIG collaborations within SBM as related to pain management. The application of behavioral management principles (integrated primary care) and use of advancing technology (behavioral informatics) could have profound effects in improving healthcare delivery and outcomes and reducing costs in this patient population. Other areas for collaboration include physical activity (promoting exercise and adherence to physical conditioning programs to improve pain and functionality), spirituality and health, complementary and integrative medicine (providing scientific evidence to highlight the potential benefit of these interventions in the pain population), ethnic minority and multicultural health (addressing disparity issues in pain medicine), and aging (managing pain in the aging population).

In the upcoming year, the Pain SIG will make strides to collaborate with other SIGs. This will include:

Joint pre-conference seminars;
Submission of symposia for the Annual Meeting that will represent perspectives from different groups (for example, the use of behavioral informatics in improving outcomes in pain medicine);
Joint sponsorship of young investigator awards; and
Developing a web blog for exchange of information among Pain SIG members and members of other SIGs and the general membership.

If you are interested in helping to promote collaborations involving the Pain SIG, please contact: Martin D. Cheatle, PhD, Chair, Pain SIG, at martin.cheatle@uphs.upenn.edu.

References

Portenoy RK, Ugarte C, Fuller I, Haas G. Population-based survey of pain in the United States: Differences among white, African American, and Hispanic subjects. J Pain. 2004; 5(6):317-328.
Pleis JR, Lucas JW. Summary health statistics for U.S. adults: National health interview survey, 2007. Vital Health Stat [10]. 2009; (240):1-159.
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Annals of Oncology. 2007; 18(9):1437-1449.
Stewart, W., J. Ricci, et al. "Lost productive time and cost due to common pain conditions in the US workforce." JAMA. 2003; 290(18): 2443-54.
National Research Counsel. Musculoskeletal disorders and the workplace. Washington, DC, USA: National Academy Press, 2001.
Oesch P, Kool J, Hagen KB, Bachmann S. Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: Systematic review and meta-analysis of randomised controlled trials. J Rehabil Med. 2010 Mar;42(3):193-205.
Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet. 2011 Jun; 377: 2226-35.
Thieme K, Turk DC, Flor H. Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome. Arthritis Rheum. 2007 Jun 15;57(5):830-6.
Kindler LL, Valencia C, Fillingim RB, George SZ. Sex differences in experimental and clinical pain sensitivity for patients with shoulder pain. Eur J Pain. 2011 Feb;15(2):118-23.


Spring/Summer 2011	Return to Outlook Main page »
Pain SIG Update Martin D. Cheatle, PhD, Pain SIG Chair "Unity is strength… when there is teamwork and collaboration, wonderful things can be achieved" (Mattie Stepanek) As active members of the Society for Behavioral Medicine we share a common vision, but we often work in silos. The gift of being a member of SBM is the opportunity to network and build collaborations across disciplines and interests. The mission statement of the Pain SIG is to "advance the understanding of pain and its treatment according to a biopsychosocial framework." We aim to achieve this mission by increasing interdisciplinary communication and collaboration with other SBM SIGs. Chronic pain has become a significant healthcare problem and a public health crisis. More than 50 million Americans suffer from chronic or recurrent pain (1, 2). The prevalence of pain in the cancer population is also noteworthy. Greater than 60% of patients with metastatic or advanced diseases, 59% of patients receiving cancer treatments, and 33% of cancer survivors experience pain, and more than a third of these patients rate their pain as moderate to severe (3). Chronic pain can impact quality of life and work productivity. The societal costs of chronic pain are also high: the annual costs of medical diagnostics and treatment, compensation for lost wages, and lost productivity has been estimated at more than 200 billion dollars per year (4, 5). The study of pain mechanisms and psychosocial processes has applications in a variety of clinical and research settings. For example, there have been meaningful developments in psychosocial and pharmacologic interventions for managing cancer-related pain and at end of life. Complicated pain patients are best treated in an integrated interdisciplinary pain program. However, the vast majority of these patients are cared for in the primary care setting where practitioners have a paucity of time, training, and resources to effectively evaluate and manage these complex pain cases. These resource constraints can lead to additional suffering and costly complications. Developing evidence-based, effective, and cost and time efficient interventions that reduce pain, improve mood and function while decreasing health care expenditures would significantly relieve the burden of pain on the individual pain sufferer and society. Although there is evidence that physical and behavioral interventions improve pain and function, there is a need for more rigorous interdisciplinary research. Systematic reviews have demonstrated a benefit of exercise in improving disability in the pain population but the overall results have been modest (6). There is an opportunity to investigate issues of adherence and which exercise type is best suited for a particular pain disorder in order to maximize treatment response (7). Likewise, psychological interventions have merit but require additional work such as matching specific patient characteristics to treatment type (8). Both physical and psychological interventions would gain from the translational research, for example, of pain sensitivity and gender response differences (9). There are numerous opportunities for cross-SIG collaborations within SBM as related to pain management. The application of behavioral management principles (integrated primary care) and use of advancing technology (behavioral informatics) could have profound effects in improving healthcare delivery and outcomes and reducing costs in this patient population. Other areas for collaboration include physical activity (promoting exercise and adherence to physical conditioning programs to improve pain and functionality), spirituality and health, complementary and integrative medicine (providing scientific evidence to highlight the potential benefit of these interventions in the pain population), ethnic minority and multicultural health (addressing disparity issues in pain medicine), and aging (managing pain in the aging population). In the upcoming year, the Pain SIG will make strides to collaborate with other SIGs. This will include: Joint pre-conference seminars; Submission of symposia for the Annual Meeting that will represent perspectives from different groups (for example, the use of behavioral informatics in improving outcomes in pain medicine); Joint sponsorship of young investigator awards; and Developing a web blog for exchange of information among Pain SIG members and members of other SIGs and the general membership. If you are interested in helping to promote collaborations involving the Pain SIG, please contact: Martin D. Cheatle, PhD, Chair, Pain SIG, at martin.cheatle@uphs.upenn.edu. References Portenoy RK, Ugarte C, Fuller I, Haas G. Population-based survey of pain in the United States: Differences among white, African American, and Hispanic subjects. J Pain. 2004; 5(6):317-328. Pleis JR, Lucas JW. Summary health statistics for U.S. adults: National health interview survey, 2007. Vital Health Stat [10]. 2009; (240):1-159. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Annals of Oncology. 2007; 18(9):1437-1449. Stewart, W., J. Ricci, et al. "Lost productive time and cost due to common pain conditions in the US workforce." JAMA. 2003; 290(18): 2443-54. National Research Counsel. Musculoskeletal disorders and the workplace. Washington, DC, USA: National Academy Press, 2001. Oesch P, Kool J, Hagen KB, Bachmann S. Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: Systematic review and meta-analysis of randomised controlled trials. J Rehabil Med. 2010 Mar;42(3):193-205. Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet. 2011 Jun; 377: 2226-35. Thieme K, Turk DC, Flor H. Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome. Arthritis Rheum. 2007 Jun 15;57(5):830-6. Kindler LL, Valencia C, Fillingim RB, George SZ. Sex differences in experimental and clinical pain sensitivity for patients with shoulder pain. Eur J Pain. 2011 Feb;15(2):118-23.