The Federal Pain Management Best Practices Inter-Agency Task Force has issued its final report and appears to want to make sure that people actually read it.
Patient-Centered Care Is Key to Best Practices in Pain Management said Vanila M. Singh, MD, MACM, Chief Medical Officer, HHS Office of the Assistant Secretary of Health, and Chairperson, Pain Management Inter-agency Task Force.
In an interview supplied by the HHS, Dr. Vanila Singh explains the work of the Pain Management Best Practices Inter-Agency Task Force.
Q: Dr. Singh, the Pain Management Best Practices Inter-Agency Task Force, a federal advisory committee that you chaired, just voted on final recommendations for pain management best practices. What was the Task Force’s charge?
A: We were charged by section 101 of the Comprehensive Addiction and Recovery Act of 2016 (CARA) – PDF to propose updates to best practices and issue recommendations that address gaps or inconsistencies for managing chronic and acute pain.
Q: What were some of your key recommendations?
A: We recommended a multimodal approach for patients who experience acute injury and perioperative pain, as well as a multidisciplinary approach for patients with chronic pain and various underlying pain conditions. Our report emphasizes safe opioid stewardship, recommending approaches that mitigate opioid exposure. These multidisciplinary approaches may include medications (non-opioid as well as opioid, depending on the individual patient’s situation), interventional approaches, restorative therapies, behavioral health interventions and other approaches.
Q: What kinds of gaps did the Task Force identify?
A: We identified a number of gaps that need to be addressed in order to improve pain management. We highlight the need for multidisciplinary approaches to chronic pain that focus on the patient’s medical condition, co-morbidities and various aspects of care including: medications, restorative movement therapies, interventional procedures, complementary and integrative health services, and behavioral health and psychological interventions. Each multidisciplinary approach would depend on clinical indication and patient specific needs.
In our recommendations, we also underscore the need to address stigma, risk assessment, access to care and education for all stakeholders. Addressing these needs and gaps will help clinicians manage acute and chronic pain in an individualized patient-centered way. The Task Force also identified special populations and certain population-specific circumstances that need to be considered during diagnosis and the development of treatment options.
Q: What did the Task Force say about the CDC Guideline for Prescribing Opioids for Chronic Pain?
A: The Task Force emphasizes individualized patient-centered care when considering pain care. While the Guideline is in line with that, and there has been progress in improving many prescribing behaviors, the Task Force recognizes that, in some cases, the CDC Guideline has been misinterpreted and misapplied. Unfortunately, unintended consequences such as forced tapering and patient abandonment contribute to adverse patient outcomes and provider disincentives in treating patients with complex acute and chronic pain.
These findings are consistent with the FDA safety announcement in April 2019 on opioid tapering and the patient harm due to forced tapering. Also in April 2019, CDC Guideline authors published a perspective piece in the New England Journal of Medicine exit disclaimer icon, indicating that some policies and practices that cite the Guideline are not consistent with its recommendations, or go beyond its recommendations, potentially putting patients at risk. Issues include application of the Guideline to populations beyond the Guideline’s intended audience, abrupt tapering or sudden discontinuation of opioids, and misapplication of the dosage recommendation to medication-assisted treatment (MAT) for opioid use disorder. I encourage everyone to read this article.
The National Pain Report will continue its coverage of the Task Force recommendations in the coming weeks as Congress and state medical boards are urged to implement some of the recommendations.