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  • Extensive Overhaul of Pain Care Needed, According to HHS, NIH

    More indications that the US health care system soon could be looking at pain in a new way: just days after the release of national guidelines recommending nondrug and nonopioid approaches in the treatment of chronic pain, the US Department of Health and Human Services (HHS) unveiled a "National Pain Strategy" (NPS) that calls for extensive efforts to rethink the way pain is treated, improve access to that treatment, and strengthen research and education across health care disciplines.

    Development of the plan began in 2011, after an HHS-commissioned report from the National Institute of Health's Institute of Medicine called for nationwide improvements in data collection on pain and its treatment, evaluations of the availability and effectiveness of care, public and professional education on pain, and translational and clinical research. The NPS released March 18 attempts to serve as a roadmap for accomplishing those improvements.

    The strategy is organized around 6 areas:

    Population research. The NPS calls for more detailed information-gathering efforts to track data around prevalence of pain overall and specific types of pain, including information on the relationship between types of pain and various population groups over time.

    Prevention and care. The strategy encourages the development of a more comprehensive view on pain that includes better evidence on pain prevention, as well as assessment tools and outcome measures.

    Disparities. In recognition of the ways pain impacts vulnerable populations, the NPS urges more work around "increasing understanding of the impact of bias and supporting effective strategies to overcome it."

    Service delivery and payment. According to the NPS, "wide variations in clinical practice, inadequate tailoring of pain therapies to individuals, and reliance on relatively ineffective and potentially high-risk treatments such as inappropriate prescribing of opioid analgesics, or certain surgical interventions, not only contribute to poor quality care for people with pain, but also increase health care costs." The fix: an "integrated, multimodal, and interdisciplinary" approach—supported by payment systems that recognize the effectiveness of that approach.

    Professional education and training. The NPS calls for improvements to various health care disciplines' core competencies to include "basic knowledge, assessment, effective team-based care, empathy, and cultural competency."

    Public education and communication. The strategy advocates for a national public awareness campaign that would provide education on the impact of chronic pain "and its status as a disease that requires appropriate treatment." That campaign would also include better information on the use—and potential for misuse—of pain medications.

    According to a news release from HHS, the NPS dovetails with the department's efforts to address the epidemic of opioid abuse, launched in March 2015. Those efforts are related to a White House initiative to battle opioid abuse and heroin use launched in the fall of that same year. APTA is among the participants in that initiative, and recently participated in a working group meeting to discuss the new US Centers for Disease Control and Prevention recommendation that nondrug, nonopioid approaches be considered the first-line treatments for chronic pain.

    Comments

    • Very interesting points here. I do think it's important that we be open to changes that could help patients. If there are findings suggesting we need to try different approaches, then it's important that we welcome it.

      Posted by Jordan on 3/23/2016 12:16 PM

    • I have been saying this for 15 years. When are we going to start really using evidence to treat patients in pain, and not use evidence paid for by industry driven research to make money. Non drug pain control starts with diet and exercise, but should also include evidence based Acupuncture, Herbal Medicine as used in China. Physical Therapy that includes massage and manual therapy, stretching and strength ex.. Herbal injection therapy as used in China. Wellness classes, in Meditation, Yoga, Tai Chi and relaxation techniques including breathing...Lets start spending money on things that work long term. Please contact me if you want to know more. Wm Scott Barnett PT GCS AP DOM

      Posted by william barnett on 3/23/2016 5:13 PM

    • What exactly are the nondrug, nonopioid approaches being considered for the first-line treatments for chronic pain? Are alternative treatments like yoga, acupuncture or medical cannabis being considered?

      Posted by ken mcgee on 3/23/2016 6:03 PM

    • We treat a large percent of chronic pain patients. Opioids are an easy short sited treatment when doctors have not been trained in alternative options: Nutrition, osteopathic manual therapy, acupuncture, self hypnosis, education and exercise/yoga/Feldenkrais options are excellent in assisting with pain control.

      Posted by Jill Thompson on 3/23/2016 8:24 PM

    • I am PT had fractured pelvis from skiing. ER wanted me to have narcotic immediately. I Said lets try ibuprofen first. They got 800 mg tablet. I am small suggested less. ER nurse said could not send back I needed to take it. I refused. I took 400mg from my ski pants pocket.(Always carry on mt for emergency.) Took pain down to tolerant level. It is easier for ER to just sedate!!! I used ibuprofen and tylenol. Had some pain but not horrible. Did gentle movements and lots of Feldenkrais.

      Posted by Gloria on 3/24/2016 12:47 AM

    • I think it important that as we become more of a mainstream resource in the management of chronic pain we do not substitute one passive approach for the pharmaceutical one currently offered. Although the various techniques and modalities referred to all have value in helping the patients increase their function--including proper use of meds-- without a large emphasis on education and some form of active program/exercise the patient is not empowered to move forward without us.

      Posted by Pierre Rougny on 3/24/2016 12:13 PM

    • Great! The CDC finally recognizes that PT's provide pain management strategies! Now, who's going to pay for it? Not Medicare! Probably not any insurer, since they'll likely follow Medicare's example of reimbursement for PT services meaning that whatever we're going to do, we'd better do it in 45 minutes and probably in no more than 8 visits. Can't wait!!

      Posted by Brian P. D'Orazio DPT, MS, OCS on 3/24/2016 10:36 PM

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