Editors’ Note

Dr. Scott Fishman is Chief of the Division of Pain Medicine and Professor of Anesthesiology and Pain Medicine at the University of California, Davis. He was formerly Medical Director of the Massachusetts General Hospital Pain Center at Harvard Medical School. His medical degree is from the University of Massachusetts Medical School. His formal clinical training is in Internal Medicine and Psychiatry. He completed Pain Medicine fellowship training through the Department of Anesthesia and Critical Care at Massachusetts General Hospital. Fishman has received board certification in Internal Medicine, Psychiatry, Pain Medicine, and Palliative Medicine. He is Senior Editor of the journal Pain Medicine and has authored The War on Pain, Listening to Pain, and Responsible Opioid Prescribing, and edited Bonica’s Management of Pain and Essentials of Pain Medicine. Fishman is President and Chairman of the Board for the American Pain Foundation. He was recently ranked by U.S. News & World Report as one of the “Top Doctors” in America.

Organization Brief

The American Pain Foundation (www.painfoundation.org; APF) is an independent nonprofit 501(c)3 organization that serves people affected by pain. Founded in 1997, APF speaks out for people living with pain, caregivers, health care providers, and allied organizations, working together to dismantle the barriers that impede access to quality pain care for all.

What is the role of the American Pain Foundation and the key areas you’re focused on?

The American Pain Foundation was formed to ensure that the consumer’s voice was represented in the growing movement to resolve the serious public health problem of undertreated pain in America.

It was formed during the early days of recognizing this serious problem with the vision that consumers would play a substantial role in the effort to fight their pain and that an organization supporting those consumers could help greatly in turning the tide on undertreated pain in America.

Is there an effective understanding of how significant the problem of undertreated pain is?

The problem of undertreated pain is well established. Members of the APF Board of Directors were part of the recent congressionally-mandated IOM review of Pain in America that reported 116 million Americans are in chronic pain. That is more than the number of people who have diabetes, cancer, and heart disease combined. This is estimated to cost $635 billion dollars each year, which substantially contributes to excessive health care costs.

Pain is the most common reason a patient goes to a doctor and surprisingly it’s barely covered in medical schools – doctors are not adequately trained to evaluate and treat it. We’re dealing with a scourge of pain-related drug use in America that, at least in part, is underscored by poor education of doctors on this subject.

It also reflects that our medical institutions have become a cure-focused force for increasing quantity of life, but we haven’t done nearly as well in improving quality of life.

The American Pain Foundation educates consumers to be their own best advocates, working to dismantle the barriers that are preventing them from receiving timely and effective access to care.

How do you get that message out?

The breadth of the organization is as broad as pain itself. It includes people with acute pain, pain at the end of life and cancer survivors, children with sickle cell disease, soldiers who have lost legs to land mines, and people with mysterious pain disorders that no one can understand, among many others painful conditions.

With over 100,000 members and growing, APF is very active in bringing pain to the forefront with people in pain as well as to the general public and the media. We have a grassroots Action Network of volunteers all across the country who work within their communities to address the need for better pain care and work with their local legislators to improve pain policy.

Pain is an alarm system that tells you there is a problem. This is when the pain alarm serves as a normal and important symptom. But when the pain alarm system becomes broken, that is when pain becomes a disease in and of itself, and a disease that is rooted in suffering and sometimes even torture for people.

So we advocate by educating people about what pain is – and not just consumers, but we also educate providers.

APF also advocates for improved social policy. The American Pain Foundation has had a substantial role in recent major medical legislation in America; it has worked in a principal role in the Military Pain Care Act and the Veterans Pain Care Act passed in 2008. APF also played a major role with the National Pain Care Policy Act, which ultimately got rolled into the health care reform bill.

How have you been working to encourage research and disseminate information?

We have been pushing for the federal government to spend more of its money on pain research – they currently spend less than 1 percent of their NIH budget on pain research. Our Vice Chairman was just appointed to an important NIH task force working on increasing pain research and its funding.

APF has also developed a broadband portal from which people can get information. The problem with the Internet is that general information can be overwhelming and much of it is poor quality or false, and some may be harmful. So APF is a clearinghouse of useful and up-to-date resources for people. Many people with pain feel isolated and alone, but PainAid, APF’s online support community, offers people with pain and caregivers numerous chat rooms and discussion boards to interact with people who have common pain issues from the convenience of their own computers.

With any new policy changes and medication safety recalls, APF sends out Action Alerts to our members. We also publish a quarterly Pain Community News filled with useful tips and resources.

How big of an issue is the misuse of pain medicines and is it being addressed effectively?

The problem with prescription drug abuse cannot be overstated. It’s an enormous problem that is consuming medicine and policy makers.

Our goal is to help make sure prescription drug abuse is addressed, while access to appropriate care for people suffering in pain is not unduly hindered. The drugs that treat pain are essential for society and we don’t want to lose that valuable arsenal. We strongly advocate for safety and effectiveness of all pain treatments.

How do you evaluate success?

When you can go to any health facility and as readily get good care for heart disease, cancer relief, diabetes control, and pain relief. Right now, we can’t say that.•