"Pain Is a Public Health Problem" --What Does That Mean and Why Should We Care?

Abstract

In recent years AAPM’s Presidents have selected a theme to emphasize during their term of office even as they continue to support the diverse range of activities conducted by this inclusive professional society. AAPM’s immediate Past President Bill McCarberg chose pain control in primary care based upon his decades of experience as a family medicine physician and pain specialist. His predecessor Sean Mackey co-chaired, with Linda Porter of the National Institutes of Health, the panel that produced a comprehensive National Pain Strategy presenting specific plans to advance multiple dimensions of pain. This monumental effort (see below) was a prime focus of his presidency. Earlier Presidents have emphasized patient advocacy, the safe use of opioids, and the needs of veterans returning from combat. I have selected “pain is a public health problem” as the focus of my term; this AAPM President’s Message describes the context and implications of this choice. In May of 1999, shortly before assuming his uniquely successful, ongoing role as inaugural Editor-in-Chief of Pain Medicine , Rollin (“Mac”) Gallagher wrote a visionary essay for a topical issue on chronic pain in Medical Clinics of North America . Titled “Primary Care and Pain Medicine”, this essay bore the subtitle “A community solution to the public health problem of chronic pain”. Drawing upon his own education (he holds a Masters in Public Health as well as an MD), he proposed a model of chronic pain that integrated – as an epidemiologist might – environment, host and causative agents in the progression from injury to chronic disability. Presciently, he called for community-based rehabilitation of the patient with chronic pain based upon a collaboration between primary care provider and pain medicine specialist. This stratified model of care was articulated further in a later white paper by Mac and two other senior leaders …