Pain Management Report Passes—What Happens Now?

The federal Pain Management Best Practices Inter-Agency Task Force has approved a draft report that is drawing generally positive reaction from the pain community.

The report, which is expected to be finalized by the end of the month, updates best practices and issues recommendations that address gaps or inconsistencies for managing chronic and acute pain.

(Here is a copy of the draft report)

6,000 individuals and over 150 organizations submitted comments earlier this year.

Task Force Chair Dr. Vanila Singh called this a “very special and pivotal moment for advancing pain management.”

The big challenge is how to get this report distributed so that better pain management and treatment can reach those who need it—the chronic pain patient.

“At the end of the day the report is a piece of paper, it’s going to mean nothing unless people advocate for change,” said Cindy Steinberg, U.S. Pain Foundation who was the only pain advocate on the task force.

The American Medical Association praised the Task Force recommendations which called for:

  • bolstering support for multidisciplinary, multimodal approaches to treating patients with acute and chronic pain;
  • reversing harmful policies such as arbitrary limits on prescribed pain medications;
  • providing individualized treatment that accounts for co-morbidities and severity, not one-size-fits-all approaches—a point emphasized recently by the Centers for Disease Control and Prevention;
  • encouraging better health insurance coverage of affordable, evidence-based non-opioid medications and non-pharmacologic treatments for pain and eliminating obstacles to treatment such as fail-first policies;

There were some critics—not surprisingly from both sides of the opioid argument.

For Richard “Red” Lawhern, who runs the Alliance for the Treatment of Intractable Pain, while praising the efforts of the Task Force, noted that it did not directly address AMA repudiation of the CDC Guideline for Opioid Prescribing.

Meanwhile, Dr. Andrew Kolodny, the executive director of Physicians for Responsible Opioid Prescribing (PROP) charged in a tweet that “opioid makers didn’t like the CDC Guideline recommendation so they got a law to create a new HHS Task Force stacked with their friends that proposed alternative recommendations.”

Nearly 20-million Americans have debilitating chronic high impact pain- defined as pain lasting than has lasted 3 months or longer that restricts daily major life or work activities.

Kate Nicholson, an attorney and pain patient advocate, praised the task force “for identifying the need for reduction of stigma of pain and the stigma related to opioids and the need for truly integrated care that covers several modalities. “

Task Force member Dr. Molly Rutherford of Crestwood, Kentucky said that she came to the task force “anti-opioid but I have more balance now” in how she treats patients.

She pointed one of the major problems in treating pain is the lack of time that primary care physicians have in treating their patients—which she called a detriment to care.

The two-day meeting wrapped up on Friday—and much of the morning was spent on the critical issue.

What happens now to this interagency effort which was led by Dr. Singh who is the Chief Medical Officer for HHS?

How can this public policy best be implemented by state and local governments, promoted by medical associations to their members and how it can influence payers and other stakeholders in the health care system?

“It’s going to take a big push from patients,” said Terri Lewis, Ph.D.

And from state officials.

Task Force member Sherif Zaafran, M.D. who is also President, Texas Medical Board, Austin, Texas promised on Twitter his board “and CMS will coordinate to make sure that we avoid unintended consequences on guidelines for pain management.”

It’s a start.

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