By Ed Coghlan.
It’s going to be the end of October before we see the set of draft recommendations of The Pain Management Best Practices Inter-Agency Task Force. Once the recommendations are released, there will be an extensive public comment period where the patients, providers, and policy makers can weigh in.
The task force was established to propose updates to best practices and issue recommendations that address gaps or inconsistencies for managing chronic and acute pain.
The U.S. Department of Health and Human Services is overseeing this effort with the U.S. Department of Veterans Affairs and U.S. Department of Defense.
The hearings in late September attracted several chronic pain advocates and federal luminaires.
U.S. Surgeon General Dr. Jerome Adams, who is an anesthesiologist with self-described “experience in acute and chronic pain”, said the process must result as a “message for effective pain management.” Dr. Adams did point out that his own brother suffered from addiction and his problems started with opioids.
Another official from CMS said that the goal is better pain management and we must get this right.
The power of the chronic pain patient was also evident.
Richard (Red) Lawhern, Ph.D. Margaret Wilson, and Trina Vaughn of the Alliance for the Treatment of Intractable Pain, attended these Task Force meeting and gave short presentations.
Dr. Lawhern sees much that is hopeful in the directions which have emerged thus far. Members and leadership of the Task Force have finally “gotten” several fundamental messages:
– Regardless of the faulty assumptions underlying the 2016CDC Guidelines, the Task Force acknowledges that there is no one size fits all patient or treatment plan. Treatment must be tailored to individuals.
– For many patients, opioid therapy will continue to be a key component of an integrated treatment plan that may include other medication and non-mediation therapies as adjuncts (not as step therapy to deny access to opioids unless all else fails).
– Tellingly, the Task Force will recommend against imposition of any mandated numerical daily dose threshold. This position in effect contradicts much of the CDC Guidelines and State regulations based on them. It will be interesting to see if the final report extends this principle to 2019 rule changes of HHS/CMS authorizing “soft” and “hard” edits of prescription plans at 50 and 200 Morphine Milligram Equivalent Daily Dose levels.
– Mandatory or coercive tapering of high dose legacy patients is unjustified and risky unless some condition in the individual patient’s health justifies such action.
The 90-day comment period will trigger a process that will result in a final report to Congress in May 2019.