The National Pain Foundation (NPF) wants to change that.

The goal of the NPF is to "provide easy access to reliable and credible information regarding treatment options for chronic pain patients," says Mary Pat Aardrup, Executive Director.

History of National Pain Foundation

Elliot Krames, MD, DABPM, Daniel Bennett, MD, DABPM, and James Hagen, MS, created the NPF in 1998 because of pain professionals' frustration that pain patients were not aware of the resources available to them early on in their pain. "People spent years and years in chronic, debilitating pain, not even being aware there were professionals in the field of pain medicine," says Aardrup.

Welcome to www.NationalPainFoundation.org!

The NPF developed a website to help persons in pain educate themselves about their pain-causing diseases and treatment options. "We conducted a series of focus groups because we wanted to find what the challenges were to the pain population and what they would like to see developed in the website," says Aardrup. "Number one," she continues, "was the lack of validation from doctors, friends, family and employers."

As a result, the organization worked to create a website that validates pain patients' experience. The NPF rolled out the first phase of the website, www.NationalPainFoundation.org, in July 2001.

The site is divided into four main sections: My Pain, My Education, My Support and My Community. Presently each section deals with five disease areas: headache, arthritis, CPRS, cancer pain & palliative care, and back & neck pain. Pediatric, pelvic and myofascial pain areas are planned for the future.

The My Pain section enables patients to inventory everything that has gone wrong with them. They can collect their thoughts and keep a journal. The patients then have substantial information about their pain experience to offer their primary care provider.

Patients who want to become more involved in developing their treatment plans can use the information found in the My Education section. This section explains the different options available within each disease area. Patients can use this information to ask their care providers about techniques and options.

The My Support section provides information about books, web links and support groups for patients.

My Community is a monitored discussion area. According to Aardrup, "It is a supportive environment that will help individuals have a sense of community and camaraderie because pain is a very isolating problem." NPF co-founder and Chairman of its Board of Directors Daniel Bennett says the NPF web community "does not have commercial biases or influences and all information provided has been peer-reviewed by multiple authorities in both conventional and complementary medicine." (See list of section editors at end of article.)

Future Plans

In 2002 the NPF expects to begin producing a website for care providers that will address issues prevalent in the provider community. "Pain accounts for 80% of all physician visits," says Aardrup, "and very few medical professionals have any professional training in pain at all."

Association with American Academy of Pain Medicine

Now that the patient website has been rolled out, how will people find out about it? "The American Academy of Pain Medicine (AAPM) recognizes the NPF as a legitimate and reliable source of pain information and support," says Aardrup. The AAPM has recognized www.NationalPainFoundation.org as its educational arm for patient education.

National Pain Awareness Week, February 26–March 2, 2002

National Pain Awareness Week, a joint undertaking of the NPF and AAPM, will take place February 26–March 2, 2002, in conjunction with the annual AAPM conference. Educational programs will be offered on topics such as opioid use, undertreatment of pain, validation of pain, new techniques, new devices and new medications.

The goals of National Pain Awareness Week are:

• educate the general public about innovations and legislation regarding pain
• increase general awareness of available options to manage pain
• build general awareness of the NPF and AAPM and their respective websites
• use the AAPM conference as the format through which to showcase new innovations.

"When I talk with patients, I pay close attention to the first thing they talk about," says Charbonneau. "Do they start off by telling me their physical symptoms, or do they comment on how tough their job is, or on a problem at home? I've learned that if you don't address the first thing the patient talks about, that person won't get better."

Charbonneau believes strongly in the value of psychological evaluations in broadening the scope of treatment to promote better outcomes. "Too often, we have labeled patients as 'non-recoverers' and showing 'failure to thrive' when the truth is we just haven't gotten to the root of the problem," he says. "I wouldn't think of running my business without including a consulting psychologist."

A team of equals

Charbonneau’s practice is one of three businesses at the Ramazzini Center™ in Greeley, Colorado. Also included are Health Psychology Associates operated by Daniel Bruns, PsyD, and Back On Track, a physical therapy clinic operated by Ola Simonsson, RPT, and Kevin Younger, RPT. The three entities work closely together to provide multidisciplinary care to their patients.

"When you build a cross-functional team, it's important to work with people whose opinions you respect highly," says Charbonneau. "We come to the table as equals to share information, and together we design a patient-specific rehabilitation program. Sometimes medical issues drive our decisions. At other times, psychological factors are foremost; and in other cases physical therapy takes the lead."

Getting to the root cause calls for effective tools

In the past, identifying psychosocial factors that may be influencing a patient's recovery has been difficult, Charbonneau acknowledges. "For some years, we didn't have really effective assessment tools," he says. "Too often, psychological evaluations looked at the patient as if life began at the time of injury or illness. They failed to look at personality development and pre-injury/illness psychological functioning. And so, de facto, psychological diagnoses were attributed to the injury."

Charbonneau comments on how the BHI™ (Battery for Health Improvement)¹ assessment has helped address this gap. "The BHI instrument helps us gain a comprehensive picture of the patient--both pre- and post-injury/illness," he says. "And most important, it is the only psychological test that is normed on physical rehabilitation patients as well as a large community sample. It uses the average physical rehabilitation patient as a benchmark for interpretations and recommendations. For the first time, we have an instrument that allows us to compare apples to apples."

The BHI assessment helps Charbonneau and his colleagues quantify the right balance between physical and psychological treatment in developing individually tailored rehabilitation plans. "No other assessment has allowed us to do that," says Charbonneau.

"Do you realize what it costs companies every day for employees to have untreated psychological conditions?"

Reducing long-term costs

But doesn't performing psychological evaluations for medical patients in the workers compensation system drive up employer costs?

• Research conducted with Bank One employees found that mental health disorders were the number one cause of absence from work and the number three cause of lower workplace productivity (Burton, Conti, Chen, Schultz & Edington, 1999).



• In a World Health Organization study of more than 26,000 subjects in 14 countries, it was found that physical disability was more closely associated with psychological factors than with medical diagnosis (Ormel, VonKorff, Utsun, Pini, Korten, & Oldehinkel, 1994).



• In a study of Boeing employees, it was found that psychosocial factors (job dissatisfaction, hysteria and antisocial traits) were better predictors of who would file a workers’ compensation claim than were 53 medical variables (Battie & Bigos, 1999).

Social workers and physicians at the Multi-Organ Transplant Center of The Methodist Hospital and Baylor College of Medicine, Houston, initially evaluate the patients. Candidates who seem to have some psycho social risk are referred for more intense evaluation to Harper and his psychiatric colleagues at the Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine.

Careful screening is critical

The candidate screening process is key to helping identify patients whose attitudes and behaviors may contribute to difficulties during both the candidacy and post-transplant phases. The transplant team needs to under stand a patient's coping skills, support system, how he or she may handle stress and illness, and especially if the patient will follow through with treatment. "There is a large array of medicines with side effects that are absolutely critical for transplant patients to take. If patients aren't religiously compliant with taking their immunosuppressants, they can end up causing organ failure," says Harper. "This is not a small matter when a donated organ that could have better served someone else fails due to a recipient’s non-compliance."

More than ten years ago, Harper and his colleagues searched for a psychological instrument that could help them screen transplant candidates. They chose the MBHI™ (Millon™ Behavioral Health Inventory) test. "We've never been sorry," says Harper. "It helps address some factors that none of the other instruments I use capture."

Understanding how patients cope

In April 2001, Harper replaced the MBHI assessment with the newly released MBMD™ (Millon Behavioral Medicine Diagnostic) assessment and is still gaining experience and collecting data with it. He notes that coping scales are at the core of both instruments.

"We can't overemphasize the value of under standing how patients cope. This may not be obvious, as seen with introversive, non complaining individuals who may under-report critical complaints," says Harper. The Millon instruments help Harper identify individuals who will need encouragement to actively participate in their healthcare.

Harper's battery of tests also includes the Mini-Mental™ State Examination for cognitive screening, Beck Depression Inventory^®, the Psychosocial Adjustment to Illness Scale, and the HSQ^® (Health Status Questionnaire) to help assess quality of life and level of functioning, along with a brief structured interview.

Other enhancements he has found especially helpful include:

• suggestions on how to approach various patients, such as those with demanding, difficult ways.



• the brief, one-page Healthcare Provider Summary, which is unique to the MBMD test.



• the formatting and language of MBMD reports, which make them more usable and friendly, especially for physicians administering the test without the assistance of a psychologist.

Absent a clear behavioral or psychiatric contraindication to performing a transplant, patients are not excluded from transplant candidacy for psychological reasons. Rather, Harper and his colleagues look for treatable psychological and behavioral risk factors the medical team would need to help the patient overcome (e.g., smoking) before proceeding with candidacy.

Harper recognizes that no instrument will perfectly capture a patient and there will always be an occasional instance where a patient isn't going to reveal everything. He thinks both the MBHI and MBMD tests are excellent instruments and says, "I'm going with the newer [the MBMD test] because it has the same sensitivities, but is just a little broader in scope. And, if I was limited to just a single instrument to use, the MBMD would be my choice."

Robert G. Harper, PhD, is Associate Professor at the Baylor College of Medicine Department of Psychiatry and Behavioral Sciences. His research has been published in several professional journals.

Back to the top

To learn more about psychological assessments for use by medical professionals, stop by the Pearson booth at the following conferences:

The National Pain Foundation (NPF)
www.NationalPainFoundation.org