Chronic Pain and Insurance: The Search for Effective Non-Opioid Relief

Chronic Pain and Insurance: The Search for Effective Non-Opioid Relief

More than one in 10 Americans say they live with chronic pain, according to the National Center for Complementary and Integrative Health (NCCIH), a division of the National Institutes of Health.

Traditionally, however, few of those patients have been steered towards non-pharmacologic - meaning non-opioid - treatment modalities. They, and their doctors, continue to rely on opioids of one sort or another, risking dependence and addiction.

Not only that, the effectiveness of the various non-pharmacologic approaches to chronic pain -everything from massage therapy and relaxation techniques to chiropractic and physical therapy - has remained relatively untried and unknown to most Americans. And that includes their physicians, who have little training in non-pharmaceutical pain solutions.

Finally, when alternative pain treatments have been recognized and sought out, too often there has been limited or even no insurance coverage available, leaving patients and well-meaning physicians with nowhere to turn except back to opioids.

Good news - insurance is expanding

Well, the good news is that in recent months, we are seeing some welcome changes in the alternative pain treatment landscape - especially from insurance companies.

For example, Blue Cross Blue Shield Association (BCBSA) is only one of several health insurance companies slowly coming around to embrace alternative, non-pharmacologic therapies.

The company states that it wants to avoid unnecessary harm for its 106 million members, and has begun promoting alternatives that include more optimal use of non-opioid prescription painkillers and existing over-the-counter pain medications.

"Due to the lack of evidence combined with significant potential for harm, we believe professional standards require that BCBS members are given alternative options to opioids in most clinical situations," said Dr. Trent Haywood, chief medical officer for BCBSA. "We will work with medical professionals to ensure BCBS members are routinely provided alternatives to opioids through a mutual decision made inside the doctor's office."

Training for doctors and pharmacists

All BCBS companies cover non-opioid pain treatment options, as well as medication-assisted treatments, the company says. The company is providing services such as "training for doctors and pharmacists, customized coaching services for those with chronic pain and support for families in addiction recovery."

"The impact of opioids in this country has been well documented," Haywood added. "Because Blue Cross and Blue Shield companies represent one in three Americans in diverse communities with diverse needs, we are taking a comprehensive approach to addressing the opioid epidemic through prevention, intervention and treatment."

In Tennessee, North Carolina and other states, BCBS is expanding coverage to include more alternative pain therapies.

Tennessee sets example

In Tennessee, for example, BCBS has been working "to curb the number of available opioids, after noting a significant increase in newborns experiencing opioid withdrawal in 2010," a company statement said.

The company added that on January 1, 2019, coverage for OxyContin was cancelled. In the U.S. Southeast, OxyContin has for years been associated with enormous addiction and overdose deaths. "We know OxyContin has become a favorite drug to abuse on the streets," said Dr. Andrea Willis, chief medical officer for BCBS Tennessee.

In its place, BCBS Tennessee now offers patients and physicians at least two alternative opioids if it is clearly the only choice. Xtampza, from Collegium Pharmaceutical, is a time-release, tamper-proof version of oxycodone with proven effectiveness to thwart abuse, and Morphabond is a long-acting morphine painkiller.

"Although the replacement drugs cost more, BCBS will keep member co-pays the same as they were for Oxycontin," the company said.

North Carolina promotes alternatives

Next door in North Carolina, Dr. Anuradha Rao-Patel, a BCBS medical director for pain management, says patients may not understand that "there are better or safer alternatives" to opioids.

"I try to look at pain from a holistic approach, treating the underlying causes as well as the immediate experience," she said recently. "We housed physical therapists right in our practice, for example. Most importantly, I've tried to focus more on improvement of a patient's function rather than elimination of pain entirely, which is often not possible. What does the patient hope to be able to do that he or she cannot do now because of pain? Play with grandchildren, go grocery shopping? And then we can develop a plan to achieve that goal."

Besides opioids, she said, there is a wide range of non-opioid medications for treating pain.

"We can prescribe muscle relaxers and anti-depressants, which have proven effective in treating some kinds of chronic pain, and drugs that treat neuropathic pain, such as for a pinched nerve or diabetic foot pain. Physical therapy, aquatic therapy and chiropractic care are also tools that we can prescribe to help manage pain.
"We've actually developed a website as a resource for providers, members and the public. It includes links to resources for providers about not only alternative pain management therapies but opioid use disorder treatment information," she added.
At Novus, we have always educated our patients in various non-pharmacological pain solutions such as chiropractic, physical therapy, massage therapy, acupuncture, plus vitamins and mineral supplements and encourage them to try different solutions and find what works for them.

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