Roger B. Fillingim, PhD, professor and director, Pain Research and Intervention Center of Excellence at the University of Florida, recently became president of the American Pain Society(APS). About 3,200 physicians, nurses, psychologists, scientists, pharmacists and others involved in the field of pain management are members of the APS.
The APS is one of several non-profit pain organizations under investigation by the U.S. Senate Finance Committee for their financial ties to the pharamceutical industry. Senators Max Baucus (D-Montana) and Chuck Grassley (R-Iowa) claim there is evidence that some drug makers funded the pain organizations to spread “misleading information about the drugs’ safety and effectiveness.” They have asked for a detailed account of all payments to the pain organizations made by Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson.
Editor in Chief Pat Anson recently spoke with Fillingim about the Senate investigation and the ongoing controversy over opioid painkillers.
Do you accept funding from pharmaceutical companies or medical device makers?
We have and we do accept funding from those groups, from a variety of industry sources, yes.
Do you put any restrictions on it, in terms of how that money is spent?
All of our money is spent to do the good work of the American Pain Society. And that work plan is decided on by our board, based on what we view as the interests of the pain care community.
We get funding from our membership dues, we get funding from registrations for our annual meeting, we get funding from various foundations to support research endeavors. We get funding from industry, who want to be present at our meeting in order to promote their products to people attending the meeting. And we get unrestricted funds from industry where there are no strings attached and we are able to do with those funds as we see fit. In every instance we have full control over content. We’re never influenced regarding what the message of the American Pain Society will be or should be. And that’s something we’ve been very diligent about, forever.
In this day and age that’s something you have to be diligent about when you’re a continuing education provider, like we are, (and that means) maintaining full control over content and insuring there are no financial conflicts of interests in determining educational content.
Dr. Lynn Webster (president elect of the American Academy of Pain Medicine) told us that without funding from industry, pain organizations wouldn’t exist and a lot of important research would never get done. Do you agree with that?
That’s true. The industry does support a robust amount of research. And, as I mentioned, we use that money to do the good work of the American Pain Society. If we didn’t have anything to do, if there was no need out there in the pain community, we wouldn’t need the money. But there’s an awful lot of work to do regarding pain education, pain research, improving access to pain treatment and all of those things require resources. We can obtain some of those resources through other sources, but we can’t do all the work that we like to do without industry funding.
For example, we have one educational program called the Fundamentals of Pain Management, which has been supported by industry for 11 years now. Every year we bring in 75 to 100 providers, physicians, psychiatrists, nurses and other allied health professionals who are interested in learning more about pain management. These are people in the early stages of their careers. We deliver a package of content over a two day period, and I’ve sent trainees of mine who are primarily researchers to this program because the content is so strong. It’s the best way to learn about pain, from soup to nuts, that I know of out there.
So the American Pain Society has put together an outstanding educational program that industry has no control over whatsoever. And thus far we’ve trained over a thousand providers in this program. That’s an example of the kind of work that we like to do. And we’re happy to take donations from people if they want to support that work, but thus far it’s been supported by industry and it’s been very effective for us and that kind of educational program is broadly needed, as I think the national community is recognizing now.
(Editor’s Note: According to ProPublica, Dr. Charles E. Argoff, a founder and chairman of the steering committee for the Fundamentals of Pain Management Course, has accepted over $139,000 in speaking and consulting fees from Eli Lilly, Pfizer, Cephalon and Johnson & Johnson since 2009.)
Are there not enough pain courses being taught in medical schools?
Oh no. It is not even close. For the number one problem that drives people to seek health care, many medical students get an hour or two of lecture about pain management in their entire medical school career. And that seems a little disproportionate to me. We have to reach out to providers and future providers where we can and seize this particular opportunity.
Do you have any concerns that the Senate investigation of the pharmaceutical industry will make companies gun shy about funding medical organizations and that your funding sources will dry up?
I’m sure that’s the case and that’s already the case.
Are you referring to the American Pain Foundation, (which recently ceased operations)?
Yes. The availability of funds from certain segments of industry is much lower than it has been in the past and so we are looking to expand sources of available funding so that we can continue to do the work that we feel is important.
I think part of that is due to the economy. There seems to be less money floating out there. Part of it is due to changes in regulations, changes in continuing medical education standards. So there are a variety of reasons for that. But I see that trend continuing and we’ll adjust and adapt and do the best we can.
So you’ve seen a decline in donations and funding sources?
Yes we have. I mean our overall revenues are probably not down by very much but we have seen some of our traditional funding sources from industry being less available. And we’ve gotten signals that that’s going to continue to be true. I do think the economy is a significant factor.
I do have concerns over time the environment is going to discourage companies from entering the pain space and patients are going to have less and less options for pain management. And I’m not just talking about pharma here, I’m talking about any company. It could be a device company, it could be a company that’s trying to develop a new biofeedback test. I’m just concerned that all of the furor over pain right now is focused on one negative area (addiction). And I’m afraid the message that pain is a huge public health problem and an inestimable private source of suffering for patients, that message is getting lost. That’s the real concern here.
In 20 years, when I’m ready for my pain management to help me get through the day and help me enjoy a quality of life, I may turn around and realize there used to be an industry that supported pain management, there used to be a segment of health care that supported that, but everyone ran away because of how scary things got back there in 2010’s.
There’s concern among some in the pain community that Big Pharma is starting to exit the pain space. They just find it too daunting to develop novel therapies for pain and that’s one of the concerns I was alluding to earlier is that potential discoveries and new products that might be helpful for patients may never be realized despite the fact there seems to be a lot of money in the pharmaceutical industry. But they are making decisions about where they can best invest their resources and many of them are deciding pain is not it, despite the fact there are 100 million customers out there who are very interested in pain management.
So while the market seems to be huge and almost unlimited, getting medications successfully into that market seems to have been very difficult, especially in recent years. I’m just sort of speculating now, not having inside information on how pharma makes its decisions, but I’m pretty confident if they knew there was good money to be made they’d still be hanging around and the fact that they’re leaving suggests that their money could be better invested elsewhere. And of course patients ultimately may be the ones who pay the price for this because there will be less availability of different pain treatments. That’s the concern.
I don’t want to minimize the fact that we do have a public health issue in terms of opioids and their potential adverse effects and their effects on society. That’s a very important issue. But we also need to recognize that we have at least 100 million people in this country suffering from chronic pain and we need to make sure that we increase the availability of treatment options, including all kinds of treatments from medications to physical therapy to psychological interventions and beyond so that patients have access to treatment that will enhance their quality of life.
I do think that in general politicians are unaware of the magnitude and nature of chronic pain as a clinical problem. There are some exceptions, but I don’t think on the whole it’s recognized how prevalent and expensive this public health condition is.
I’m just hoping we can take a rational approach, that we can let science be at the center of the decisions that we make rather than politics and that we can do what’s in the best interests of both our patients and our society. The FDA has a tough job on its hands. We all have a difficult job ahead of us managing chronic pain while minimizing societal adverse consequences. And it’s not going to be easy.
Thank you, Dr. Fillingim.