The [Institute of Medicine] committee [has] identified several important barriers to adequate pain care in the United States. These include the magnitude of the problem, provider attitudes and training, insurance coverage, cultural attitudes of patients, geographic barriers, and regulatory barriers.
Institute of Medicine, 2011
The complexity of our fragmented healthcare system creates significant barriers to effective pain management in all areas of medicine and across all age groups. Treating pain in a system that is struggling to contain costs means better education and training, better interdisciplinary communication and cooperation, and better reimbursement for proven treatment options are desperately needed.
According to the Institute of Medicine, treatment of pain is often disorganized, ineffective, and inaccessible. Many members of the public, people with pain, and many health professionals are not adequately prepared to take preventive action, recognize warning signs, initiate timely and appropriate treatment, or seek specialty consultation when needed (IOM, 2011).
Costly, inappropriate, or inadequate procedures are sometimes carried out when other approaches—such as counseling, prevention, and self-management—might be more appropriate. There is significant variability among clinicians in applying new and even existing knowledge about pain and its management. This is reflected in the documentation of inappropriate—or indeed lack of—treatment for cancer patients, HIV/AIDS patients, and neonates, and post operative pain (Sessle, 2012).
To address these barriers, the Institute of Medicine (IOM, 2011) has recommended:
The inadequate education of healthcare professionals is a major and persistent barrier to effective pain management. Despite the health professions’ development of competencies in pain management, as well as the myriad guidelines and position articles on pain management issued by numerous professional bodies, core pain management competencies for pre-licensure, entry-level health professionals have not yet been established. The limited pain education that is currently provided may be ineffective because it focuses on traditional, impersonal topics such as anatomy and physiology that may have little direct relevance to the complex daily problems faced by patients, families, and clinicians (Fishman et al., 2013).
The Institute of Medicine has stated that pain education is critically important and that the federal government is in a position to contribute to improvements in patient and professional education about pain. The IOM recommends that the medical professionals (1) expand and redesign education programs, (2) improve curriculum and education for healthcare professionals, and (3) increase the number of health professionals with advanced expertise in pain care (IOM, 2011).
The American Academy of Pain Medicine has echoed the IOM recommendations by publishing a set of inter-professional core competencies for pain management, which are categorized within four domains. These domains address (1) the fundamental concepts and complexity of pain; (2) how pain is observed and assessed; (3) collaborative approaches to treatment options; and (4) application of competencies across the lifespan in the context of various settings, populations, and care team models (Fishman et al., 2013).
Understanding of the phenomenon of pain, its immediate and long-term consequences, and its effective management is lacking or is minimal in many health science curricula, including those for nursing. This lack of knowledge and effective translation into a usable form for practitioners raises the following question: Do graduates have sufficient knowledge and skills to be competent in giving appropriate pain management to their patients (Herr et al., 2015)?