Integrative and Functional Medicine advocacy and peer organizations recently put out a call for practitioners in the field to comment on a new Federal program to examine gaps in Pain Management in this country.
The Comprehensive Addiction and Recovery Act (CARA) of 2016 led to the creation of the Pain Management Best Practices Inter-Agency Task Force, whose mission is to determine whether gaps in or inconsistencies between best practices for acute and chronic pain management exist and to propose updates and recommendations to those best practices. The Task Force consists of 29 experts who have significant experience across the disciplines of pain management, patient advocacy, substance use disorders, mental health, and minority health. This draft report describes preliminary recommendations of the Task Force that will be finalized and submitted to Congress in 2019, following a 90-day public comment period.
Initial key concepts in the report mirror our practice model, and more specifically our own Pain Management program at Lake Travis Integrative. These include, among others:
- Balanced pain management should be based on a biopsychosocial model of care.
- Individualized, patient-centered care is vital to addressing the public health pain crisis.
- Multidisciplinary approach to chronic pain that focuses on the patient’s medical condition, co-morbidities, and various aspects of care Multi-modal approach
- Access to care is vital .
- Stigma is a major barrier to treatment, so it is important to provide empathy and a non-judgmental approach to improve treatment and outcomes.
- Education through societal awareness, provider education and training, and patient education are needed to understand choices and promote therapeutic alliances between patients and providers.
- Innovative solutions to pain management such as telemedicine, tele-mentoring, mobile apps for behavioral and psychological skills, newer medicines, and medical devices should be utilized as part of the overall approach to pain management.
- Research is required to develop a better understanding of the mechanisms of pain, preventive measures, the use of innovative medical devices and medications to prevent the acute-to-chronic pain transition, and methods to improve outcomes of chronic pain conditions.
In spite of the fact that I have employed complimentary and alternative modalities in managing chronic pain for more than three decades, I was recently shocked to learn in my studies with the Andrew Weil Center for Integrative Medicine’s Pain Management program that most pain management practices in the conventional model have no evidentiary basis.
This is certainly the case for interventional pain management. Interventional techniques are minimally invasive procedures like needle placement of drugs in targeted areas, ablation of targeted nerves, and some surgical techniques such as discectomy and the implantation of intrathecal infusion pumps and spinal cord stimulators. There is a noted lack of evidence in interventional pain medicine, yet many new studies are still observational or retrospective of these procedures with biases that overestimate the success of such interventions.
Our team feels strongly about promoting a better standard of care for all, including biopsychosocial (mind-body-spirit) approaches and complimentary modalities. There is no excuse for bypassing the evidence or over reliance on pharmaceutical industry dogma.
After the publishing of this draft report and a request for public comment, we became aware that those many stakeholders in the current paradigm are not supportive of integrative approaches. These providers submitted comments arguing for a continued reliance on pharmacological approaches to pain.
Pharmaceuticals occupy a much needed space in the continuum of care, for instance after surgery or traumatic injury. And yet they have limited or no efficacy for pain on the chronic spectrum. No one working in healthcare today can argue that we don’t have an epidemic caused by short sightedness and over reliance on drugs alone.
For this reason, our team was encouraged to comment for the public good on this important issue. My comment to the committee:
The efficacy of a biopsychosocial model of care and CAM with pain control is proven in the literature, by patient and practitioner accounts, and is now being advised as first line standard of care national specialty organizations. And yet the conventional pain management consortium in this country lags behind.
Analysis of opiate prescriptions from 2000-2010 reveals that the number of opiates prescribed rose by over 100% yet pain metrics have not declined. People are still in pain! The rate of death from opioids – both illicit and prescription – has steadily risen from 2000 until present by 200%. The rate of death from overdose for women from prescription pain medication rose 400% from 1999 to 2010. The Surgeon General of the United States himself in August 2016 asked 2.3 million health care practitioners across the country to recommend non-pharmacological approaches as first line pain treatment, with opioids to be considered only if these and non-opioid pharmacological treatments are ineffective.
I wholeheartedly support the recommendations in this report. We can and we must change the universal standard of care in Pain Management in this country.
There is no shame in needing pharmaceutical relief when pain is a daily part of your life challenges.
And now we know…there is so much more to explore. I, for one, am grateful that the federal government has caught on.
Relief is on the horizon!
DG Merrill; Hoffman’s glasses: evidence-based medicine and the search for quality in the literature of interventional pain medicine. Reg Anesth Pain Med. 2004 Jan-Feb;29(1):79.
Francesc Borrell-Carrió, MD; Anthony L. Suchman, MD; and Ronald M. Epstein, MD; The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry, Ann Fam Med. 2004 Nov; 2(6): 576–582.
Office of the Assistant Secretary for Health; Pain Management Task Force; Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations, 2019