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6 Articles in this Series
Introduction
Where Are We With a National Pain Strategy?
Prevalence of Growth Hormone Deficiency in Fibromyalgia
The Perfect Storm: Chronic Pain, Inflammation, and Dysfunctional Sleep
Ketamine and Pyschotherapy Effective for Management of CRPS and PTSD
Using a Multimodal Approach to Physical Therapy for Chronic Pain
Combining Noninvasive Brain Stimulation Therapies for CRPS

Where Are We With a National Pain Strategy?

The director of the NIH Office of Pain Policy predicts what is ahead for practitioners.

The need for a National Pain Strategy is evident from the statistics alone. In the US, 100 million adults report chronic pain, with 25 million reporting it daily.1 About 8 million people say pain interferes with their lifestyle. Despite this sobering scenario, access to quality care is limited.1

That was the message delivered by keynote speaker, Linda Porter, PhD, director of the National Institutes of Health's Office of Pain Policy at the Academy of Integrative Pain Management 27th annual meeting in September.1

Her subtitle—Balancing Care and Risks—also hit home with the audience.

"The message we have been trying to get out there is that there are a huge number of people affected by pain,'' Dr. Porter said. The nation's pain specialists need to provide better pain care, and "rather than opioids, we need to offer people with pain something else,''1 she said.

Here are the goals outlined for the National Pain Strategy,1,2 the federal government's first coordinated plan for reducing the national burden of chronic pain:

  • Building an evidence base about what works for chronic pain, with an eye to reducing reliance on opioids to control the opioid epidemic
  • Educating the public about living with chronic pain
  • Educating doctors at the primary care level about pain management
  • Improving coverage for pain management

"We are trying to pull together what the evidence basis is for different treatments so we can get [patients] coverage," Dr. Porter said.1,2 Next, educating physicians and other providers about what works and what doesn't is crucial, she said.

Under the national strategy, federal officials hope to develop and update core competencies for pain care education, licensure, and certification at both the undergraduate and graduate levels.1,2

Informing payers, including Medicare and private carriers, about the evidence basis is an important avenue to improved coverage and another critical step, according to Dr. Porter.1

"The doctor can then say [to the patient], 'These are the 3 things you can do for your pain and your insurance will pay for it,'"1 Dr. Porter said. "There are so many different pain conditions that respond to different treatments," she said. The research focus must now be on a multidisciplinary approach.1

One notable trial, she highlighted, is the Collaborative Care for Chronic Pain in Primary Care project,3 led by Lynn Larson DeBar at the Kaiser Foundation Research Institute. It will evaluate the integration of psychosocial services into the primary care environment and then evaluate the effectiveness of the approach to pain management in the primary care setting.

The new model, and the new ''buzzword," Dr. Porter said, is a focus on patient-centered integrated pain management practices based on a biopsychosocial model of care. This will allow both providers and patients to access the full spectrum of options for treating pain.

The timeline for getting this policy set is slower than ideal, Dr. Porter acknowledged. "It's going to take time," she said. "But I'm very excited this is happening.'' Some substantial headway will be made within 5 years but not all the objectives will be realized by then. "What we expect are gradual changes."

"Over time,'' she said, the National Pain Strategy ''will help us understand how people live with chronic pain every day and how providers can help with their burden."1

Perspective from PPM's Editor-in-Chief

Forest Tennant, MD, DrPH, a Los Angeles area pain management specialist and editor-in-chief of Practical Pain Management, put the presentation in perspective.

"I think Dr. Porter and the committee have done a good job in putting together the plan," he said. "I don't think they could have done any better." However, he had a substantial caveat: "It will be of no help to the practicing physician for quite some time, several years," he said, citing the time required to build the evidence basis and complete the other goals.

"At this time," Dr. Tennant said, "every practitioner in every community is on their own." He pointed to an inability of pain management specialists to form a single cohesive organization as another obstacle to providing better pain management, noting that several pain organizations have split off from each other and don't coordinate efforts. "The National Pain Strategy is trying to close that vacuum," he said.

Until the goals of the National Pain Strategy become reality, what can practitioners do? Get together with colleagues to learn about new protocols, the nonopioid treatments, Dr. Tennant suggested. “Exchange ideas informally.”

 

References

1. Porter L. Keynote address. Presentation at: Academy of Integrative Pain Management 27th annual meeting; September 21-25, 2016; San Antonio, TX.

2. Intragency Pain Research Coordinating Committee. National Pain Strategy. Available at: https://iprcc.nih.gov/National_Pain_Strategy/NPS_Main.htm. Accessed October 21, 2016.

3. DeBar LL, Kaiser. Foundation Research Institute. Collaborative care for chronic pain in primary care. Available at: https://painconsortium.nih.gov/pragmaticclinicaltrials.pdf. Accessed October 21, 2016

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