- HHS has released a draft report proposing recommendations to improve the nation’s pain management strategies and reduce the devastating impact of improperly used opioids on population health.
The report, published by the Pain Management Best Practices Inter-Agency Task Force established in 2016, is designed to close gaps in best practices and offer updates to current standards for managing acute and chronic pain.
“Chronic pain affects an estimated 50 million US adults or 20 percent of the adult population,” said Vanila M. Singh, MD, MACM, Task Force chair, and chief medical officer of the HHS Office of the Assistant Secretary for Health. “An estimated 19.6 million U.S. adults have experienced high-impact chronic pain, which the CDC defines as pain occurring and interfering with life or work activities most days.”
“This draft report offers a wide range of treatment modalities with a framework to allow for multidisciplinary, individualized patient-centered care.”
The report suggests a significantly more holistic approach to pain management, embracing the idea that treatment pathways should be individualized and based on a “biopsychosocial model of care.”
Individuals in need of treatment for pain should be assessed for the risk of addiction or improper usage before beginning an opioid, and providers should first explore alternative services, such as physical therapy, cognitive behavioral therapy, or even complementary options such as acupuncture or tai chi.
“Innovative solutions to pain management such as telemedicine, tele-mentoring, mobile apps for behavioral and psychological skills, newer medicines, and medical devices should be utilized as part of the overall approach to pain management,” the report adds.
The Task Force acknowledges that providers may not have the organizational resources to integrate these new solutions into their pain management choices, keeping opioids at the center of many treatment plans.
At the same time, stricter regulations around opioid dispensing, including pill limitations and enhanced enforcement for prescriptions deemed improper, have left some providers wary of using the medications at all.
This has led to some patients being denied access to an effective and necessary treatment, leading to dire consequences.
“Public comments submitted to the Task Force show growing consideration of suicide resulting from unrelieved pain and in some cases lack of access to treatment,” the report observes.
In order to ensure that patients in true need of opioids can receive their medications while reducing the potential for new patients to become addicted to the drugs, HHS is aiming to “recalibrate” the nation’s approach to helping individuals manage their pain.
“The Task Force recognizes that comprehensive pain management often requires the work of various health care professionals, including physicians, dentists, nurses, pharmacists, physical therapists, occupational therapists, behavioral health specialists, psychologists, and integrative health practitioners,” the report says.
“Achieving excellence in patient-centered care depends on a strong patient-clinician relationship defined by mutual trust and respect and, in the case of chronic pain, empathy and compassion on the part of the health care provider.”
The report strongly recommends that providers in all care settings develop a multimodal and proactive approach to pain management, of which opioids are only one possible component.
Improving perioperative pain management by integrating additional screenings, pain management techniques, and types of pain medications could significantly reduce the risk of developing a dependence on opioids.
In addition, using advanced data analytics to create condition-specific treatment pathways, instead of using opioids as a one-size-fits-all option, could ensure that patients receive more targeted therapies with fewer risks of addiction or improper use.
States should work more closely together, and with federal authorities, to improve the design and use of electronic prescription drug monitoring program (PDMP) databases, which allow entities to engage in analytics and prevent overprescribing to individuals.
Providers should also receive more robust pain management education to prevent them from relying on opioids too heavily, the report suggests. At the same time, patients should receive more education about using their medications and storing them safety to prevent unintentional drug diversion.
Psychological interventions will play an important role in helping individuals manage their pain and succeed with alternate treatment pathways, the report stresses.
Individuals with chronic pain often experience mental distress, may have coexisting disabilities, and are more likely to engage in maladaptive coping behaviors, the Task Force notes.
Ensuring access to behavioral healthcare and mental healthcare will be key to successfully treating individuals with pain that affects their daily functioning, as well as helping individuals with recognized substance use disorders maintain a high quality of life.
mHealth apps and mobile devices will be important for expanding access to behavioral health services, the report added. The industry will need to develop validation processes to assess the usefulness and usability of data-driven care options.
Interested stakeholders have until March 28, 2019 to submit comments on the framework’s suggestions.
“We encourage members of the public to review the draft report and share their comments with us,” Singh stated.