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  • APTA Contributes to New 'Playbook' on Pain Management and Opioid Stewardship

    Understanding the link between overreliance on opioids for pain management and the broader opioid crisis in the US isn't difficult: identifying realistic steps to break that link is another matter. A high-profile national partnership that includes APTA is hoping to change that with the release of an opioid "playbook" focused on realistic, patient-focused, and scalable actions to transform health care's approach to pain.

    The National Quality Partners Playbook: Opioid Stewardship, released on March 12, aims to provide "a blueprint to help address the nation's devastating opioid epidemic," according to Shantanu Agrawai, ME, MPhil, president and CEO of National Quality Forum (NQF), which sponsored the creation of the resource. The guide is the product of an NQF "action team" composed of representatives from more than 40 health care and provider organizations including the US Centers for Disease Control and Prevention, BlueCross BlueShield Association, the American Nurses Association, the American Society of Health Systems Pharmacists, Magellan Health, and the Veterans Health Administration. APTA was represented on the action team by Alice Bell, PT, DPT, senior payment specialist for the association.

    The playbook is built around 7 "fundamental actions" that authors believe could help shift health care patterns away from the overuse of opioids for noncancer pain. Those actions are rooted in the concept of opioid "stewardship"—the idea that health care systems, clinicians, and patients must take a shared approach to the use of opioids that recognizes their potential for harm and looks to nonopioid options whenever possible. Those actions are:

    • Promoting leadership commitment and culture that support nonopioid pain treatments and demonstrates that support through allocation of resources
    • Implementing organizational policies to support evidence-based approaches to multimodal pain management
    • Advancing clinical knowledge, expertise, and practice to ensure that clinicians understand the science of pain and techniques for patient communication
    • Enhancing patient and family caregiver education and engagement around pain management and the risks of opioids
    • Tracking, monitoring, and reporting performance data on opioid prescribing, patient-reported outcomes, and adverse events
    • Establishing accountability around communicating and maintaining "a culture of opioid stewardship"
    • Supporting collaboration with community leaders and stakeholders to achieve maximum impact

    "The playbook highlights the importance of incorporating a multidimensional approach to pain management, including physical therapy, as a critical component of addressing this epidemic in a meaningful way," said Bell. "The diverse group of organizations and individuals who contributed brought a comprehensive perspective and a real commitment to providing a useful and effective tool to health care organizations and providers."

    The recommendations from the NQF group are consistent with APTA's #ChoosePT opioid awareness campaign, which stresses the importance of clinician-patient communication about pain management. Many of the playbook's themes were also echoed by participants in a recent live FaceBook broadcast from APTA, "Beyond Opioids: Transforming Pain Management to Improve Health."

    "It's critical that health care organizations and providers examine their approaches to pain management to ensure that individuals are aware of all of their options, including more active approaches to care, such as physical therapy," Bell said. "The playbook creates a pathway for making these needed changes at such a critical time—this epidemic continues to impact so many, and the need for a collaborative solution is clear."

    The playbook was released in conjunction with the opening day of the NQF annual conference, which features a panel discussion on the resource. Additionally, NQF will host a public webinar on March 29 and an in-person workshop on May 1 in Washington, DC.

    NQF is a nonprofit organization known for developing resources in the areas of health care quality measurement and improvement. The opioid playbook was 1 of 2 such resources released on March 12; the second is a playbook addressing shared decision-making in health care.

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    • Have you considered alternative methods of treatment such as TRE. Trauma Releasing exercise created by David Bercelli? This method is simple to learn and helps people down regulate their nervous systems to decrease stress. I have been a PT for 26 years and have not found a better tool to assist clients. Check it out and please contact me if you have any questions

      Posted by MARY GORMAN on 3/15/2018 3:33 PM

    • Does the playbook plan have any recommendations about the importance of preventing chronic pain to begin with? Does it talk about early physical therapy intervention in the treatment of acute musculoskeletal injury to keep acute pain from becoming chronic pain?

      Posted by Philip Paul Tygiel PT, MTC on 3/19/2018 1:15 PM

    • @Philip - Because the playbook is not a pain management playbook, but rather an opioid stewardship playbook, it does not get into the specifics in this area. It does, however, promote early access to pain management options.

      Posted by APTA Staff on 3/20/2018 9:22 AM

    • Thank-you, Alice Bell, for representing PT and APTA on this NQF action team. And congrats to APTANJ on getting "physical therapy" wording included in P.L. 2017, Chapter 28 (approved 2/15/2017). This law requires prescribers of Schedule II CDS & other opoids for chronic pain to establish a "pain management agreement" to "identify the specific medications and other modes of treatment, including physical therapy or exercise, relaxation, or psychological counseling, that are included as a part of the pain management plan".

      Posted by Cindy Moore on 3/26/2018 12:39 PM

    • Please Alice Bell, effort to impress upon the team to take action to remove the stigma that we are left to manage pain rather than treat it. End processes as the focus is EXACTLY what has us (not just the US but the world) in trouble with pain. Pain is better treated than managed; if we are really changing then please change the terminology. Therapeutic Neuroscience Education (TNE) is a very effective RCT supported intervention tool. Extremely strong evidence supports Pain Neuroscience Education (PNE) inclusion in core curricula at all levels from elementary education science through medical academia.

      Posted by John Lowry PT on 12/16/2018 11:02 PM

    • What about people with Rheumatoid arthritis? Do you have a play for that? How about neuropathy?

      Posted by Chalifoux Tracy on 2/2/2020 11:24 PM

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