Pain Management Task Force Releases Best Practices for Fighting Chronic Pain
A draft report from the Pain Management Best Practices Inter-Agency Task Force, which acts in an advisory capacity for the federal government, contains new guidance for pain management in the United States in the age of the opioid epidemic.
Creating a Pain Management Task Force: The Comprehensive Addiction and Recovery Act (CARA) of 2016 led to the creation of a 29 member task force whose main mission was 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. This task force consists of experts who have significant experience across the disciplines of pain management, patient advocacy, substance use disorders, mental health and minority health.
They have found that pain management should be balanced, individualized, multidisciplinary and multi-modal.
The Main Pain Management Findings: The recommendations from the task force are multidisciplinary in nature and encourage doctors treating chronic pain patients to use treatment modalities like acupuncture, massage therapy and physical therapy. Opioid prescriptions are to be considered within the patient’s history, which should result in better risk assessment and lower rates of addiction. For surgical and acute situations, a “multi-modal” approach is recommended.
The task force further introduced a new term for pain management professionals to learn: “chronic relapsing pain conditions.” These conditions “include a lengthy list of degenerative, inflammatory and neurologic conditions, such as multiple sclerosis, cancer, trigeminal neuralgia, lupus, Parkinson’s disease, postherpetic neuralgia, CRPS, porphyria, lupus, lumbar radicular pain, migraines and cluster headaches.”
With that in mind, “chronic relapsing pain conditions” is a term used to recognize pain as heterogeneous. The draft report said usage of the umbrella term “chronic pain” can be considered problematic, because “there are multiple potential causes of worsening pain that are often not recognized or considered. Non-tolerance-related factors include iatrogenic (medical related) causes such as surgery, flares of the underlying disease or injury, and increased ergonomic demands or emotional distress.”
The Task Force’s Main Point: The biopsychosocial model underlies the entire report, which asks the medical community to treat the entire person, rather than just the disease state. This may include cognitive behavior therapy, social workers or nutrition education. In chronic pain patients, reducing stigma is a major goal of the model.
Limitations: While the task force promotes the biopsychosocial model, the model still has its downsides. It includes treatments like acupuncture and psychological intervention that may increase the cost of claims over the short term. In addition, pharmaceutical companies are developing new opioid drugs that are still gaining approval from the FDA, albeit with lower abuse potential, undercutting the industry’s commitment to curbing opioid abuse.
Why it Matters: The Pain Management Best Practices Inter-Agency Task Force represents a serious step in the right direction to end the opioid epidemic, but the plan’s effectiveness will depend upon the medical community’s willingness to change course and prepare for a more individualized approach to pain. &