Long-Awaited Pain Management Draft Report Released

Long-Awaited Pain Management Draft Report Released

The long-awaited "Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations" has finally been released.

The federal draft report, released in late December, 2018, calls for a "patient-centered approach" to improved treatment of pain from all causes among all patient populations.

The report is the result of over two years of investigation by the Pain Management Best Practices Inter-Agency Task Force, a federal advisory committee established under Section 101 of the Comprehensive Addiction and Recovery Act (CARA) of 2016.

Because of the intimate causal relationship seen between prescription opioid painkillers and the opioid epidemic, CARA established the task force to obtain more detailed information regarding their clinical use in pain management.

Nicknamed the "opioids bill" at the time by lawmakers and the media, CARA passed with sweeping bipartisan approval, the first-ever federal legislation supporting long-term addiction treatment and recovery. For more details about CARA, read our report.

The 29-member Task Force includes federal employees, healthcare providers and even some patients. Under the direction of Health and Human Services (HHS), Department of Veterans Affairs, and Department of Defense, it was charged with analyzing what's right and what's wrong with existing policies and practices for managing chronic and acute pain in all settings, and to come up with some solid recommendations for improvement.

Some details from HHS

The draft report calls for:

  • 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.
  • Ensure better and safer opioid stewardship through risk assessment based on patients' medical, social, and family history to ensure safe and appropriate prescribing.
  • Multidisciplinary approach to chronic pain that focuses on the patient's medical condition, co-morbidities, and various aspects of care including:
  • Medications. Different classes depending on patient medical conditions and history.
  • Restorative movement therapies. Physical and occupational therapy, massage therapy, aqua therapy.
  • Interventional procedures. Different types of minimally invasive procedures can be important for both acute and chronic pain.
  • Complementary and integrative health. Acupuncture, yoga, tai chi, meditation.
  • Behavioral health/psychological interventions. Coping skills, cognitive behavioral therapy.
  • Multi-modal approach to acute pain in the surgical, injury, burn and trauma setting.
  • Perioperative surgical home and acute pain guidelines to provide a framework for improved patient experience and outcomes.
  • Addressing drug shortages that might affect acute and chronic pain care.
  • Access to care is vital through improved health care coverage for various treatment modalities and an enlarged workforce of pain specialists and behavioral health clinicians to help guide and support appropriately trained primary care clinicians.
  • 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.
  • Special populations are highlighted, including pediatric, women, older adults, American Indians/Alaskan Natives, active duty soldiers/veterans, sickle cell disease (as an example of a chronic relapsing condition).

The report also allows for input from the general public during a 90-day period following its release last December. Interested parties have until the end of March to offer comments, which are required to follow the guidelines for submissions detailed here. The report will be finalized and delivered to Congress following the 90-day comment period.

"Chronic pain affects an estimated 50 million U.S. adults or 20 percent of the adult population. An estimated 19.6 million U.S. adults have experienced high-impact chronic pain, which the CDC defines as pain occurring and interfering with life or work activities most days. This draft report offers a wide range of treatment modalities with a framework to allow for multidisciplinary, individualized patient-centered care," said Dr. V. M. Singh, chairman of the task force and chief medical officer of the HHS Office of the Assistant Secretary for Health. "We encourage members of the public to review the draft report and share their comments with us."

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