Task force: Effective pain management needs to go beyond medications

03 Jan 2019 | SOURCE: FierceHealthcare

Opioids

A federal task force is calling for a far more individualized approach to pain management in the wake of the opioid epidemic.

In a draft report, the Pain Management Best Practices Inter-Agency Task Force said effective pain management needs to take into account all aspects of a patient including his or her biology, social ties and psychology.

That means looking beyond medications to manage pain, instead of simply finding alternatives to opioids, according to the report. Physical therapy, alternative therapies like acupuncture, activities like yoga and tai chi, and cognitive therapy are all components to be considered in a treatment plan.

“The practice of pain management and the opioid crisis have influenced each other as they have each evolved in response to different influences and pressures,” the task force said in the report.

“It is imperative to strike a balance between ensuring that patients with painful conditions can work with their healthcare providers to develop an integrative pain treatment plan that optimizes function, quality of life and productivity while also ending the devastating effects of opioid misuse.”

The task force, which was convened as part of the Comprehensive Addiction and Recovery Act of 2016, includes providers, patients and government employees. It’s spearheaded by the Department of Health and Human Services, with cooperation from the Department of Defense and the Department of Veterans Affairs.

The report noted that chronic pain is a widespread problem in the U.S., impacting 50 million adults, or 20% of that population. Of those, an estimated 19.6 million experience “high-impact” pain, which interferes with daily life and work activities. That raises the stakes in finding alternatives, according to the task force.

The push for new approaches to pain management must be bolstered by additional research into the “mechanisms” of pain and to establish better guidance for the warning signs of a transition from acute to chronic pain and ways to improve outcomes for patients with chronic pain.

This includes better education for both patients and providers, both on care options and to reduce the stigmas associated with pain and addiction, according to the report. The task force highlights several patient populations that should be focus areas, including children, women, the elderly, Native Americans, active duty soldiers and patients with sickle cell anemia

Clinical teams also need to be trained to more frequently and effectively screen patients for opioid addiction risk and need to be educated on overdose treatments, too—including potentially offering naloxone to any patient who receives an opioid prescription.

In addition to offering several areas to improve or innovate pain treatment, the task force also suggests that Congress mandate a review of the Centers for Disease Control and Prevention’s 2016 guidelines on prescribing opioids to patients with chronic pain.

Interpretations of the CDC’s recommendations and gaps in the suggestions have had “unintended consequences,” according to the report, leading some to misinterpret or misunderstand the guidelines. Updating the guidelines to meet the latest science and to address those gaps is crucial.

“A more even-handed approach would balance addressing opioid overuse with the need to protect the patient-provider relationship by preserving access to medically-necessary drug regimens, and reducing the potential for unintended consequences,” the task force said.

HHS will accept public comments on the report for 90 days.

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