Dr. Lynn Webster: Hello, this is Dr. Lynn Webster, thank you for listening to this question and answer series on lynnwebstermd.com. Today I am proud to have Dr. Sean Mackey with me. Dr. Mackey is the immediate past president of American Academy of Pain Medicine and Professor of Anesthesiology at Stanford University. Thank you for joining me today Dr. Mackey.
Dr. Sean Mackey: Dr. Webster, Lynn, it is great to be here with you.
Dr. Lynn Webster: We have had some big news this last week, the government has come out with, the NIH has come out with their National Pain Strategy. Can you give the listener some idea of what this is and why that’s important?
Dr. Sean Mackey: Yeah, this is probably the most important document related to pain that has come out in the last four years. So the National Pain Strategy is the document of action that is a followup to the Institute of Medicine pain report. Now let me explain what I mean by that. So to give the background on this, the Institute of Medicine put out a report on ‘Relieving Pain in America’ in June of 2011, and I was honored to be on that 19-member committee that wrote that. In that document we outlined the burden of pain, we identified 100 million Americans suffering from pain and half a trillion dollars a year that we spend each year caring for people in pain. We outlined a number of findings and recommendations that crossed pain care, prevention of pain, pain research, pain education, disparities related to pain, and we put that all together into this blue print that outlined a very high level what we need to do to actually change things in our country and then hopefully for the United States to be a leader for the rest of the world.
So that document came out which was a very high level document, what we needed next was a strategic plan, how to actually implement the components that were in the IOM report and that’s what the National Pain Strategy is. It is a document of action. It specifically outlines targeted goals that have identified who are the stakeholders, who are the people responsible for these goals, how we are going to measure whether we actually achieve these goals and it talks about the importance of these goals in the context of the Institute of Medicine report. So in brief this is an incredibly important document, one that we can all get behind, and one that, if enacted, if we enact these goals that are set forward into it will make an astounding difference in the lives of people who are suffering from pain at an individual level that also have a huge impact on society itself.
Dr. Lynn Webster: You know I think you could touch upon what’s really important, particularly for the listeners, because I think most of the listeners are people who have experienced pain or their caregivers to people in pain, can you break it down to a personal level, give me an example of how this might help somebody who is in pain?
Dr. Sean Mackey: Certainly. So, much like you Lynn I have spent much of my career taking care of people who have been living with pain, living with pain for very long periods of time where it has taken over their lives, consumed every part of them as well as their family and I have dedicated my life to working to find ways both from a clinical care standpoint, both from research in our lab and from an educational standpoint to helping reduce pain and suffering in people who have chronic pain.
You asked for an example, let’s choose an example. Right now in the way we reimburse for pain care in society, often the things that we find can work the best, that has the best data behind it and that being team based comprehensive care is not appropriately reimbursed or supported in our country. We do a very good job of reimbursing people, reimbursing physicians, psychologists, physical therapists, actually quite frankly we don’t do a good job in reimbursing psychologists but in a lot of the providers we do a great job in reimbursing them to do things to patients, to do surgery, to do procedures, to hand out a pill. We don’t do a great job in helping to bring teams of people together, each with different areas of expertise to take a comprehensive look at the person who is suffering from pain to put together a coordinated care plan and then to enact that using a team-based approach. We have been missing that. This is one area that we have taken on in the National Pain Strategy to call for a revision of the way that we reimburse, we incentivize and try to move the needle over more towards this type of team based care. So that’s one example that I think would have a huge impact on people who are suffering from pain.
Dr. Lynn Webster: Well we both know that there has been a trend over the last decade of less of that multi-disciplinary approach and more individual single modality, you and I refer to it as monomodal approach to treating pain and that has not served the pain community well. So we need to go back to what we have demonstrated 40 years ago which is the multimodal multidisciplinary integrative approach which is what you are describing, is that correct?
Dr. Sean Mackey: That is absolutely correct, and while there was probably more of it talked about back in the ’70s, the ’80s, the early ’90s, the reality is that we never truly disseminated that model throughout our culture and throughout our country. It remained within relatively small pockets of large academic centers, large healthcare institutions and they did a great job in researching it and writing it up and there was good data that came from it. What is exciting now is that decades later we have so much better tools to bring to bear. We have much better approaches to pain psychology, physical therapy, the pharmacologic tools we have are much better than what we were doing in the ’90s and the ’80s, and so it is an incredible opportunity to bring to bear these 21st century tools, but rather than doing them piecemeal, to truly do them in a coordinated team based approach.
Dr. Lynn Webster: Is the National Pain Strategy a theory, is it a blueprint or does it actually tell us how we can achieve what you have just described?
Dr. Sean Mackey: So this is one of the many things that I have to credit then Assistant Secretary of Health Howard Koh with directing us. So Dr. Koh specifically told Dr. Linda Porter and I, we were both co-chairing this effort, that he wanted a tactical document. He did not want pie in the sky, we are going to cure pain type of goals. These goals had to be specific, they had to be measurable, they have to be actionable, they have to relevant, they have to be time based, so I don’t know if you were just noting but I just used the acronym for SMART, and thereby definition meant to be SMART goals, and anybody who is looking at this or listening to this and look up SMART goals and you will see that that’s how we framed these goals. And so they were put into context of one-, two-, and three-year plans from a time-based standpoint and within each of these goals they had not only have a time basis to it but they also define how we are going to measure the particular impact and outcome of each of these, so it is not a blueprint, it is a tactical document on how to achieve each of these short, intermediate, and long term goals.
Dr. Lynn Webster: You know I personally am very excited about our government setting out a tactical plan to improve the lives of millions of Americans and I am proud to be a part of a field that is really going to have that kind of an impact, and I am even probably more proud to know you because you have been the principal leader, one of the principal leaders in advocating for this, so I want to thank you for that. But before we leave Dr. Mackey, can you tell the listeners, most of whom will be people in pain more than likely, what one thing or two things they can do to help us achieve the goals that have been defined by the National Pain Strategy?
Dr. Sean Mackey: Yes. So the first message is a broad one which is going to be ‘get involved.’ When this is ultimately released, we are going to need everybody getting behind it with one voice. Right now, just to orient the listeners, the document has been put out for public commentary under a 45-day federal public commentary period, it will then go back to Health & Human Services where it will be appropriately revised, we will take the public comments into account and then ultimately we expect to see its final release. When it is finally released, that’s when we all need to mobilize. We need to come together. One of the things that I am working on, and Lynn we have been working on this together through our academy efforts, is to mobilize professional and medical associations and patient advocacy groups and work together to define some clear sound bites, some clear messaging that we can all get behind in this NPS. We need to speak with a single common voice about pushing these goals forward, so to the extent that listeners can help with that that will be wonderful.
Additional help is going to be when this is released. Reach out to your congressman or congresswoman and let them know how important this is, because it is going to take Congress, it is going to take legislators at the local, state and national levels to support this effort. And then it is going to go beyond that because we are going to have stakeholders across all branches of government and it is going to need also to engage patient advocacy groups, the professional medical associations, the education groups. So this is going to take a concerted effort; it is not going to be easy, but this is where we need each and every person listening here to lend a hand.
Dr. Lynn Webster: When do you think the final report would be made public?
Dr. Sean Mackey: I wish I had a crystal ball Lynn. I have learned to appreciate that Health & Human Services wants to do things right, and sometimes doing things right does take time. So I appreciate that sounds little bit like a deflection but I think the short answer is I don’t know but that we are in constant contact with them. I can tell you that from the conversations I have had, that they are very much behind getting this document out, getting it into the hands of the American public and we are all going to work hard to make that happen.
Dr. Lynn Webster: But you would say that there is no reason why the listeners couldn’t get involved and be active at this time?
Dr. Sean Mackey: I think now is a great time to get active. So make your voices known, your thoughts known during this 45-day commentary period, send the email in and Lynn I will assume that you are going to post the link on your website, if not I can provide you one to where they can send it, even if it is the briefest one line message saying ‘I support the National Pain Strategy. This is incredibly important for me, my family, and the country’ even that counts. If you have more a constructive thoughts, you want to go into deeper by all means we want to hear your thoughts, and that’s what you can do now. Also get involved with your patient advocacy groups because they are very tuned in with this, get involved with the professional medical associations if you are a healthcare provider. We are all looking to mobilize people to make this a reality.
Dr. Lynn Webster: I think it is going to be an interesting time, very exciting, over the next two to three years, certainly over the summer to see how all of this develops and hopefully the final report will be out early this fall. That’s what I am predicting or at least I am hoping. So, Dr. Mackey, thank you very much for participating today in the Q&A series here on lynnwebstermd.com. For the listeners I want to thank you as well. Please come back and check my blog for future questions and answers along this series. If you aren’t already, please follow me on Twitter @LynnRWebsterMD and stay tuned to my blog for more information about my upcoming book and documentary titled The Painful Truth, to be released sometime this Fall. Coincidentally along with probably the final report on the National Pain Strategy. Thanks again and have a great day.
Link to the draft National Pain Strategy:
Sean Mackey, MD, PhD
Redlich Professor, Stanford Division of Pain Medicine
Chronic pain afflicts approximately 100 million people in the US, and associated yearly healthcare costs exceed half a trillion dollars. Under Dr. Sean Mackey’s leadership, researchers at the Stanford Pain Management Center and the Stanford Systems Neuroscience and Pain Laboratory (SNAPL) have made major advances in the understanding of chronic pain as a disease in its own right, one that fundamentally alters the nervous system. Dr. Mackey has overseen efforts to map the specific brain and spinal cord regions that perceive and process pain, which has lead to the development of a multidisciplinary treatment model that translates basic science research into innovative therapies to provide more effective, personalized treatments for patients with chronic pain.
Under Dr. Mackey’s leadership, the Stanford Pain Management Center has been designated a Center of Excellence by the American Pain Society, one of only two centers to receive this honor twice. Dr. Mackey is Immediate Past-President of the American Academy of Pain Medicine, and in 2012, U.S. News and World Report named him as among the top 1% of pain doctors in the US. In 2011 he was a member of the Institutes of Medicine committee that issued the report on Relieving Pain in America. Dr. Mackey has served as principal investigator and investigator for multiple NIH grants to investigate chronic pain and to investigate novel analgesics for acute and chronic pain. Dr. Mackey has published over 100 articles and book chapters. He is a member of several professional organizations, serves on the several journal editorial boards and is a reviewer for multiple scientific journals. He recently served on the Institute of Medicine committee to assess the national state of pain care, education and research. He is currently Co-Chair of the Oversight Committee for the NIH/Health and Human Services effort to establish a national health strategy for pain care, education and research. He annually presents papers and lectures at both national and international Pain Medicine, Neuroscience and Anesthesiology meetings and has been interviewed extensively by the popular press (http://paincenter.stanford.edu/press).
Dr. Mackey received his BSE and MSE in bioengineering from the University of Pennsylvania and his MD and PhD in electrical engineering from the University of Arizona. In 1994 he completed his anesthesia residency and a fellowship in pain medicine at Stanford. Since 2007, Dr. Mackey has served as Chief of the Division of Pain Medicine and director of the fellowship program in the Department of Anesthesiology, Perioperative and Pain Medicine.