This article features an interview with Bob Twillman, PhD, FAPM, executive director of the Academy of Integrative Pain Management (formerly the American Academy of Pain Management). Dr. Twillman is a pain psychologist and a national expert on federal and state pain policies. He is a strong advocate for an integrative and common sense approach to pain management.
Pain SIG: What is the National Pain Strategy?
Twillman: Mandated as part of the Patient Protection and Affordable Care Act, the National Pain Strategy (NPS) is a document created by 80 national experts in various areas of pain management. It outlines a strategy for addressing the public health crisis represented by chronic pain and focuses on six areas of activity: (1) population research, (2) prevention and care, (3) disparities, (4) service delivery and payment, (5) professional education and training, and (6) public education and communication. In each of these areas the NPS lays out short-term, intermediate-term, and long-term strategic goals. The content of the NPS is organized around addressing the findings presented in the Institute of Medicine’s 2011 report, Relieving Pain in America, and calls for implementation of an integrated approach to pain care—one that is interdisciplinary, multimodal, and patient-centered.
Pain SIG: What do you see as the strengths and limitations of this strategy?
Twillman: The greatest strength of the NPS lies in its comprehensive nature and the robust development process. A review of the six subject areas that I previously mentioned indicates that the NPS addresses not just research and clinical pain care, but also public and professional education and disparities. Further, it focuses not only on care for people who already have pain, but also on primary and secondary prevention strategies that might enable people to avoid developing chronic pain. To have such a comprehensive strategy developed by the leading experts in pain management is truly valuable. But the greatest limitation of the NPS lies in the fact that it is just a document outlining a strategy. While this is a great start, it is just a framework, and it needs urgent work to build out a tactical response, not to mention Congressional appropriations to pay for it.
Pain SIG: SBM, along with 72 other organizations, recently endorsed a letter that you initiated to the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) on an implementation plan for the National Pain Strategy. Can you tell us about this letter and why it’s important?
Twillman: As it exists now, the NPS is just a strategy. Its lack of an implementation plan and the funding to carry out that plan means that, until much more work is done, this report, like many other government reports, is in danger of becoming another dusty tome on someone’s bookshelf. The letter to the Senate HELP Committee urged the committee to demand a written implementation plan, with a budget needed to carry it out, from the Department of Health and Human Services (DHHS) within 60 days of a request from the committee. To date, we have not seen this request from the committee, but several groups have met with the appropriate people within DHHS and confirmed that work on an implementation plan and budget is well underway. The goal of the DHHS staff is to complete that plan before the Obama Administration leaves office.
Pain SIG: Can the SBM community help? If so, what can SBM members do to join the effort, and get a plan and budget from Congress?
Twillman: Yes! There are two things that SBM’s members can do now to help implement the NPS: