IOM Report Takes Closer Look at Relieving Pain

Relieving Pain in America publication coverA new report by the Institute of Medicine* notes that pain is more than a physical symptom and that treatment is not always resolved by curing the underlying condition.

Among the findings in Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research is that even though pain is universal, it is experienced uniquely by each person and care must be tailored.

Social workers who have spent years studying the complexities of pain management say the report will serve as a vital guide in promoting the study of and treatment options related to suffering.

“I am excited by the report,” said Shirley Otis-Green, a palliative care social worker. “I think it provides a strong foundation and it serves as a reminder of the complexity in managing pain.”

Otis-Green is a senior research specialist for the Division of Nursing Research and Education in the Department of Population Sciences at the City of Hope National Medical Center in California. Her extensive background in the field includes being a principal investigator of two National Cancer Institute-funded grants, the ACE Project and ExCEL in Social Work, and she developed the nationally recognized Promoting Excellence in Pain Management and Palliative Care for Social Workers course.

Otis-Green said social workers can make a tremendous contribution to the management of a person’s pain experience. Those in the profession are sensitive to the multidimensional aspects of suffering and bring sensitivity to how different cultures and personalities express pain.

“We as social workers are change agents,” she said, adding that all social workers can benefit by reviewing the IOM report.

The committee that wrote the document is calling for coordinated national efforts among public and private organizations to create a “cultural transformation” in how the nation understands and approaches pain management and prevention.

The IOM publication references social work a few times. It notes that licensed clinical social workers are among the trained professionals whom people in pain turn to address their concerns.

The report also describes several models of pain management programs, noting that one of the programs — the Brigham and Women’s Pain Management Center in Boston, which received national recognition from the American Pain Society as a Clinical Center of Excellence in 2007 and 2011 — includes social work services. Moreover, the report calls for research on social work and other interventions for pain in primary care settings.

Successful treatment, management and prevention of pain require an integrated approach that responds to all factors that influence pain, the committee concluded.

Another social worker who has an extensive background in pain management is Terry Altilio. She is the social work coordinator at the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City. She and Otis-Green edited the textbook Palliative Social Work.

Altilio said social workers understand that emotional pain can be equal and greater than physical pain for many people. While medical professionals often seek medicinal methods to treat pain, social workers are skilled in using a person-in-environment approach.

“We view the spiritual, economical and social aspects of a person’s environment,” she explained.

Pain is complex because is it subjective, Altilio pointed out. “Since you can’t measure pain there is the opportunity for projecting or diminishing it,” she said.

She suggested social workers examine the IOM report and apply their skills in the call for change.

“It’s time for our profession to share ownership of this and seek the learning necessary to apply our skills and perspectives,” Altilio said.

In other palliative care news, NASW staff and other members of the National Coalition for Hospice and Palliative Care Coalition met with representatives from the Joint Commission recently to exchange information about the Joint Commission’s new Advanced Certification for Palliative Care program.

The certification is designed to recognize hospital inpatient programs that demonstrate exceptional patient and family-centered care in order to optimize quality of life for patients with serious illness.

Programs may begin the application process by visiting the Joint Commission Certification for Palliative Care Programs section.

Certification requires adherence to the Joint Commission’s standards for palliative care certification, which stipulate that the palliative care interdisciplinary term include a social worker — preferably one with specialty training in palliative care.

Exchanging information with Joint Commission staff was beneficial, said Chris Herman, NASW senior practice associate.

“The meeting provided an excellent opportunity to let the Joint Commission know about the NASW-NHPCO (National Hospice and Palliative Care Organization) certifications as one indicator of social work expertise in palliative care,” Herman said.

In a related note, the Center to Advance Palliative Care has developed a guide to help palliative care programs prepare for certification. CAPC also hosts a free online discussion forum for social workers in hospital-based palliative care programs. See CAPC Forums.

*The Institute of Medicine is now part of The National Academies of Sciences, Engineering, and Medicine.

Get a copy of the National Academies’ pain report.