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Pain Medicine: The Case for an Independent Medical Specialty and Training Programs

Dubois, Michel Y. MD; Follett, Kenneth A. MD, PhD

doi: 10.1097/ACM.0000000000000265

Over the last 30 years, pain has become one of the most dynamic areas of medicine and a public health issue. According to a recent Institute of Medicine report, pain affects approximately 100 million Americans at an estimated annual economic cost of $560 to $635 billion and is poorly treated overall. The American Board of Medical Specialties (ABMS) recognizes a pain subspecialty, but pain care delivery has struggled with increasing demand and developed in an inconsistent and uncoordinated fashion. Pain education is insufficient and highly variable. Multiple pain professional organizations have led to fragmentation of the field and lack of interdisciplinary agreement, resulting in confusion regarding who speaks for pain medicine. In this Perspective, the authors argue that ABMS recognition of pain medicine as an independent medical specialty would provide much needed structure and oversight for the field and would generate credibility for the specialty and its providers among medical peers, payers, regulatory and legislative agencies, and the public at large. The existing system, managed by three ABMS boards, largely excludes other specialties that contribute to pain care, fails to provide leadership from a single professional organization, provides suboptimal training exposure to pain medicine, and lengthens training, which results in inefficient use of time and educational resources. The creation of a primary ABMS conjoint board in pain medicine with its own residency programs and departments would provide better coordinated training, ensure the highest degree of competence of pain medicine specialists, and improve the quality of pain care and patient safety.

Dr. Dubois is Joyce H. Lowinson Professor of Pain Medicine and Palliative Care and professor of anesthesiology, New York University (NYU) School of Medicine and Langone NYU Hospitals Center, New York, New York.

Dr. Follett is professor and chief, Division of Neurosurgery, and Nancy A. Keegan and Donald R. Voelte, Jr. Chair of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Dubois, 30 East 65th St., New York, NY 10065; telephone: (212) 988-0402; e-mail:

© 2014 by the Association of American Medical Colleges