An Institute of Medicine report identifies pain as a major public
health problem that will require physicians to team with psychologists
to address its biological, psychological and social underpinnings.
BY BETH AZAR
If the recommendations of a new Institute of Medicine report get implemented, the way clinicians, researchers and patients approach pain management will place more
emphasis on the psychological and social aspects of pain, says
psychologist Francis Keefe, PhD, who sat on the committee that
wrote the report.
That shift from a biological model of pain — where pain is
considered a sensory response to a specific injury — to a more
integrated model that includes biological, psychological and
social factors should spur a move toward team-centered pain
management that includes primary-care physicians, nurses,
physical rehabilitation specialists, and psychologists and other
mental health professionals, says Keefe, professor of medical
psychology and professor of psychology and neuroscience at
The report, released in June and titled “Relieving Pain in
America: A Blueprint for Transforming Prevention, Care,
Education, and Research,” emphasizes the need to treat pain
as an independent disease, at least in some cases, not simply a
byproduct of another disease or injury. In fact, says the report,
pain is one of the biggest public health problems in the United
States, with an estimated 116 million Americans living with
pain — more than those affected by heart disease, diabetes and
cancer combined. Acute and chronic pain costs the country an
estimated $635 billion each year in medical treatment and lost
The hope is that the findings regarding biopsychosocial
aspects of pain highlighted in the report will trickle down to
primary-care settings where people typically seek help for pain,
says Keefe. It is becoming clear that primary-care physicians need
to better understand the psychological and social underpinnings
of both acute and chronic pain and that psychologists need to
better understand how to integrate psychological models of pain
with pharmacological and surgical interventions.
APA’s Education Directorate, in conjunction with APA’s Div.
38 (Health), has been working for years to develop educational
competencies for training programs that prepare psychologists
to work in primary care and health-care settings, including
training in pain management, says Cynthia Belar, PhD, APA’s
executive director of education.
In addition, APA has advocated for insurance
reimbursement policies that support team-based approaches to
care — a specific recommendation made in the IOM report.
Overall, “the report fits nicely within APA’s strategic plan,
which focuses on the need for better integrated care,” she says.
Among the report’s calls for action are:
• Creating a comprehensive strategy for pain prevention,
treatment, management and research.
• Supporting collaborations between pain specialists and
• Designating a lead institute at NIH responsible for moving
pain research forward.
• Expanding and redesigning education programs to
transform the understanding of pain.
• Increasing support for interdisciplinary research in pain.
• Increasing the training of pain researchers.
The report speaks to more than 30 years of efforts to reshape
how people think about pain, says psychologist and IOM
committee member Robert Kerns, PhD, national program
director for pain management of the Department of Veterans
Affairs and professor of psychiatry, neurology and psychology
at Yale University. This report represents a turning point in that
thinking, he says.
“Over-reliance on a purely biological perspective on pain
often contributes to an enormous amount of suffering and
increased cost,” adds Keefe. “This report holds out the hope that
by using a broader, biopsychosocial approach to pain, much of
that suffering and cost can be prevented.” n
Beth Azar is a writer in Portland, Ore.
To download a copy of the IOM report go to www.iom.edu/