The Evolution of Pain Medicine: Residency Training for Health Care Reform

Abstract

For many years the American Academy of Pain Medicine (AAPM) has worked to improve pain care by seeking the American Board of Medical Specialties' (ABMS) recognition of pain medicine as a medical specialty and by urging the Accreditation Council for Graduate Medical Education (ACGME) to accept residency programs in pain medicine. Although the changes sought in pain care have been undertaken to bring cohesion to a fragmented practice area, these changes have been viewed as revolutionary to other interests. Our initial efforts, however, have been only shortcomings in the sense that they did not bring about a revolution in pain care. But revolution is not the only way to bring about change. The AAPM is achieving its goals and recognizes that the dedicated efforts throughout the years have begun to deliver tangible benefits. We are taking significant steps down the path that will lead to the necessary changes in pain medicine. We are changing pain care by evolution rather than by revolution. As outlined in the Pain Medicine Position Paper in this issue of Pain Medicine , a confluence of forces propels this evolutionary process. First, there is the progression of our science, a rapid acceleration in our understanding of the physiology and treatment of acute pain, and the epidemiology, pathophysiology, and treatment of maldynias, the diseases of chronic pain. We are challenged to translate this knowledge into an effective pain management strategy for the population we serve. We are gradually overcoming policies that perpetuate inadequate training and fragmented, cost-ineffective care. Second, there is the public demand for better care, defined in this era as improved access to quality care at a lower cost. Taxpayers, employees, and employers are now burdened as a result of an inadequate management of pain in our population. Policy-makers are seeking leadership from organized medicine …