TARGET Chronic Pain Initiative

Ed. Note: The following is a press release from the American Pain Foundation

Identifying and Treating Components of Chronic Pain Can Improve Pain Management

BALTIMORE, April 7 -- Successful pain management requires effective communication and an ongoing partnership between pain patients and healthcare providers. The American Pain Foundation (APF) today launched the TARGET Chronic Pain Initiative to encourage better communication between these two partners and thereby improve pain management.

The program acknowledges that clinicians receive little education on pain management during their medical training -- including diagnosis and treatment -- and face time constraints during patient appointments. Simultaneously, patients don't always know how to describe their pain and often don't recall how their pain has varied over time. In addition, research has shown that because pain is identified principally through self-reports, patients who have difficulty communicating with clinicians are at particular risk of undertreatment. All together, these lead to increased difficulty in diagnosing and treating pain, and hinder patients' ability to be an active participant in their own care.

The new APF initiative addresses this predicament by providing both patients and providers with resources to focus on a common language to distinguish and describe the main components of chronic pain -- including persistent and breakthrough pain. Persistent pain is continuous pain that is present for most of the day, persists for more than three months and is usually treated with medication taken around-the-clock. Breakthrough pain (BTP) -- a sudden flare of pain that "breaks through" the relief provided by around-the-clock medication used to treat persistent pain -- is an often- misunderstood aspect of chronic pain that requires a tailored strategy for care.

"Good pain management begins with clear and comprehensive communication between the patient and the healthcare provider. By giving patients and their healthcare providers tools that use consistent language to describe the complex phenomenon of chronic pain, patients and clinicians can interact more productively. This is a critical step to facilitate accurate diagnosis and treatment of chronic pain," commented Chris Miaskowski, PhD, RN, FAAN, APF board member, and chair, Department of Physiological Nursing at the University of California, San Francisco. Dr. Miaskowski contributed to the development of the new tools.

New Tools Designed to Facilitate Communication Between Patients and


APF's new initiative includes two tools, the TARGET Chronic Pain Notebook for patients and the TARGET Chronic Pain Card for clinicians. The pieces complement each other and are designed to guide patients and providers into using a common vocabulary when describing persistent and breakthrough pain. This is the first time that APF has developed materials to support clinicians, and is based on the organization's belief that clear and consistent two-way communication between patients and providers is essential to good pain management.

Focus-group testing conducted with chronic pain patients revealed that patients describe their pain in many different and personal ways, and are often unconcerned with specific clinical descriptions. However, often patients do not receive the relief they need because they have difficulty communicating the difference between increased levels of persistent pain vs. breakthrough pain episodes. The tools help patients to identify the types of pain they are experiencing -- and the terms used to describe the pain -- to more effectively and efficiently communicate with their medical team and achieve optimal pain control.

"We hope to improve the success of pain management for patients by making it easier for them to describe their pain and get the help they need to achieve relief, and to improve their ability to function on a day-to-day basis," says Claudia Campbell, BSN, RN, CCRN, Manager of Pain Services, Intermountain Healthcare in Salt Lake City, Utah. "One important part of describing pain is recognizing that there are different components that can occur simultaneously, like persistent and breakthrough pain." Ms. Campbell contributed to the development of the TARGET Chronic Pain Card.

TARGET Chronic Pain Notebook -- Designed as a workbook for pain patients or their caregivers, the notebook provides various methods to record the daily pain experience and treatment regimen, in words and graphics. Pain sufferers should share the completed notebooks with their clinicians to provide information about the long-term pain experience, efforts to relieve the pain, and areas of need. Research demonstrates that information recorded by patients in notebooks/charts helps healthcare professionals understand the long-term impact of the patient's pain, thus assisting them in making treatment decisions.(ii)

TARGET Chronic Pain Card -- Created as a quick reference for healthcare professionals in pain assessment and management, the card features key questions to ask patients about pain, tips on treatment strategies based on accepted principles of pain management, and charts that can be used as visual aids to explain the components of chronic pain to patients.

Both pieces can be ordered from APF by calling 1-888-615-PAIN (7246) or through the Web site at The Target Chronic Pain Notebook can be downloaded directly from the site. APF already has distributed a limited number directly to oncologists and pain specialists.

Impact of Chronic Pain

More than 50 million Americans live with serious chronic pain that interferes with day-to-day functioning in their personal, social, and work lives. If pain is untreated, it can worsen other health problems, slow recovery, and interfere with healing. Followed by cancer and heart disease, chronic pain is the third leading cause of physical impairment in the United States.(iii) Up to 86 percent of Americans suffering from chronic pain experience breakthrough pain -- even when the persistent pain is well managed.(iv)

About APF

The American Pain Foundation is an independent, non-profit organization serving people with pain through information, advocacy, and support. Our mission is to improve the quality of life for people with pain by raising public awareness, providing practical information, promoting research, and advocating to remove barriers and increase access to effective pain management.

The American Pain Foundation is solely responsible for the content, and maintains editorial control, of all materials and publications it produces. APF gratefully acknowledges those who support our work. The publications announced in this press release were underwritten with an unrestricted educational grant from Cephalon, Inc.

(i) American Pain Society. Principles of Analgesic Use in the Treatment of Acute and Cancer Pain. 5th ed. Glenview, IL: American Pain Society; 2003.

(ii) McMillan C. Breakthrough pain: assessment and management in cancer patients. British Journal of Nursing. 2001;v.10,n.13:860-866.

(iii) American Academy of Physical Medicine and Rehabilitation; American Chronic Pain Association

(iv) Fine PG, Busch MA. Characterization of breakthrough pain by hospice patients and their caregivers. J Pain Symptom Manage. 1998; 16(3):179-183.

Lennie Duensing
American Pain Foundation

Beth Townsend
Cooney/Waters Group