This special issue of Federal Practitioner is dedicated to the topic of pain man- agement in the federal health care sys- tem. There has been a great deal of
effort to raise awareness regarding the importance of pain assessment and appropriate
management over the last decade. This has
greatly improved access to care; unfortunately,
much remains to be done. This issue presents
review articles by very skilled and experienced
pain management clinicians, who deal with
complex issues and patients with chronic pain
on a daily basis, and have done so for many
years. They have seen the transformation, but
have also realized that many new problems
have emerged.
The article by Dr. Jennifer L. Murphy and
her colleagues summarizes the evolution
and current state of the system-wide efforts
made by the Veterans Health Administration
to implement state-of-the-art, comprehensive pain management using a 3-tiered system that starts at the primary care level and
progresses all the way to tertiary pain evaluation and management centers. The authors eloquently explain the components of a tertiary
pain care center and clearly state the importance of interdisciplinary collaboration for improved outcomes. The article also emphasizes
the importance of administrative and budgetary support for appropriate implementation in
the Veterans Administration system.
The article by Dr. Ryan Keneally and his
colleagues discusses some of the mitigation
strategies for medication misuse in active military personnel; a problem that has become a
major public health issue not only in the federal health care system, but also for this nation
as a whole. The authors appropriately emphasize the importance of establishing safeguards
when prescribing opioids, specifically the importance of a very thorough assessment before
engaging in chronic prescribing, as well as the
importance of periodic reviews and monitoring.
The article by Dr. John F. Peppin and
Dr. Kenneth L. Kirsh provides a great overview
of the potential adverse effects of opioid an-
algesics. The authors emphasize that these
compounds are not innocuous and should be
used with great care, rather than being stan-
dard care for all patients with chronic pain.
Ramon L. Cuevas-Trisan, MD
Chief, Physical Medicine, Rehabilitation,
and Pain Management Services
West Palm Beach VA Medical Center
West Palm Beach, Florida
