Policy Issues Affecting Nursing Pain Management: A New Decade of Hope

Pain touches each of us in some way during our lives. The varied approaches to pain treatment education and subsequent locale, state, or national policy will likely impact pain outcomes. In 2020, twenty percent of the global population experienced chronic pain. China and the United States have higher rates of chronic pain at 39% and 30% respectively. Chronic pain is the top cause of disability in the United States. Annually, the United States spends $560 billion due to chronic pain, and 20% of Americans report that chronic pain severely impacts their sleep (Edgson, 2020). To illustrate these points, Wang et al. (2020) found that 20% of older adults report that pain interferes with sleep. The authors concluded that older adults with dementia and severe pain were at greater risk of poorly treated pain. Most importantly, severe pain in people with dementia is a significant predictor of unplanned facility admissions (hospital, nursing home, or rehabilitation facility).

As is apparent, to form pain policy, one must first define pain. The late Margo McCaffery pioneered one of the most common definitions of pain as “Whatever the experiencing person says it is, existing whenever and wherever the person says it does” and further added that without self-report, there could be no assessment of pain intensity (Pasero & McCaffery, 2005). In the current special edition, Anderson and colleagues (Anderson et al., 2020) synthesize the literature on defining pain, particularly in people with Alzheimer’s disease (AD). A critical discussion point is that until the scientific community understands how AD impacts central pain processing, tool development will be disadvantaged. Fortunately, research on the impact of AD and central pain processing is growing (Beach et al., 2015; Cole et al., 2006; Cowan et al., 2017; Monroe et al., 2017; Romano et al., 2018). Until we understand the neurobiology of pain in AD, efficient treatment will remain a substantial and vital policy issue affecting nearly 50 million people worldwide (Hirtz et al., 2007). Additionally, this underscores the need for appropriation of federal funding for AD research and other mechanistic approaches to understanding pain.

Since the early 1990’s the concept of assessing pain in people with AD during movement was conceptualized as a more precise measure of pain-related behavior in people with AD (Feldt, 2000). To date, there dozens of tools in use to assess a myriad of behavioral indicators of pain with no single tool uniformly recommended. Almost thirty years later, the notion of assessing pain in someone during movement in all older adults is strategically proposed as a paradigm shift to movement-based pain assessment in older adults, as suggested by (Booker, Herr & Horgas, 2020). For example, stoicism and the belief that pain is a normal part of aging prevent some persons from seeking pain care (Gammons & Caswell, 2014). Still, assessing pain during movement might empower clinicians and clients to begin conversations about numerous options for treating pain that may otherwise go unrecognized or unreported.

Others discuss the issue of pain management in the context of pain in the new decade. Aronowitz and colleagues expose the need for innovative approaches to educating future clinicians about policies regarding opioids, pain, and addictive disorders (Aronowitz et al., 2020). Specifically, the authors call for increased education of clinicians worldwide about opioid use disorders and to consider harm reduction techniques such as medicated assisted treatment, which may help save lives from opioid overdoses. In a similar vein, Wilson et al., (2020) discuss the ethical, legal and policy implications for using a shared decision making for patients using cannabis for pain symptom management in the United States.

Numerous authors in this special edition have posited that improved pain policy is needed to relive suffering and it is important to note important resources currently available for advancing pain policy. For example, pioneering work on pain policy development has been at the forefront of several policy groups. For the last several decades the Pain & Policy Studies Group (PPSG) at the University of Wisconsin Carbone Cancer Center has worked to improve access to opioids worldwide. The PPSG has worked with the United Nations to promote adequate opioid access by assisting various governments to overcome regulatory barriers blocking adequate pain management. The PPSG is considered one of the leading experts on pain policy and government drug control (Cleary & Maurer, 2018).

Another key resource for pain management policy is The Pain Management Best Practices Inter-Agency Task Force Report Final Report. The 29-member Task Force was convened by the U.S. Department of Health and Human Services, the U.S. Department of Defense and the U.S. Department of Veterans Affairs alongside the Office of National Drug Control Policy to address acute and chronic pain during the opioid crisis. The Task Force determined that the focus should be on patient-centered care in the diagnosis and treatment of pain. Key outcomes in the treatment of pain should be measurable such as improved quality of life, function, and activities of daily living. The extensive report suggests that in addition to medications, pain care should focus on restorative therapies, interventional approaches, behavioral approaches, and complementary and integrative care (U.S. Department of Health and Human Services, 2019).

The above is only a sampling of the many topics discussed in this Special Edition. As you read through the exceptional research, education, practice, and paradigm-shifting theories, you will enjoy novel articles about managing pain in people with traumatic brain injury, managing pain using complementary and alternative therapy, addressing pain in pediatric populations, and remarkably insightful policy analysis regarding adult self-management of chronic pain.