Organizing health services for patients with chronic pain: When there is a will there is a way

Setting. Due to its magnitude as a health problem, its associated burden, and the viability of modes of intervention, chronic pain (CP) should be considered a priority within health care systems. The lives of many patients with CP are devastated by this problem and health care professionals have a responsibility to assist them in reducing their suffering. Countries, regions, and systems differ considerably with regard to how they organize, administer, and finance services for CP patients. Objective. In this review, we highlight initiatives in three jurisdictions-France, Australia, and the Veterans' Health Administration in the United States-which demonstrate that when there is a will there is a way to change health care services for patients with CP. This work is a synopsis of a health technology assessment report we completed on behalf of the Quebec Health Services and Technology Assessment Agency (http://www.aetmis.gouv.qc.ca) at the request of the Ministry of Health and Social Services in Quebec, Canada, to inform policymakers at various levels of the health care system. Design. A literature search of published and unpublished "gray" literature was used to identify organizational themes according to structure, process, and outcome elements of health care services. For each theme, literature was reviewed in a qualitative manner; in addition, "real world" information was sought from example jurisdictions that have prioritized management of CP. Our conclusions point to key issues to consider when organizing health services for CP patients.