Subscription is FREE for qualified healthcare professionals in the US.
14 Articles in Volume 19, Issue #1
Analgesics of the Future: NKTR-181
Antidote to CDC Guideline; Plantar Fasciitis; Patient Input
Assessing and Treating Migraine in Women and Men
Demystifying Opioid-Induced Hyperalgesia
Editorial: Have We Gone Too Far? Can We Get Back?
How to Compel Patients to Complete Home Exercises
Inflammation Targeted Nanomedicine
Intravenous Stem Cell Administration for Ileitis
Invasive Surgery: Effective in Relieving Chronic Pain?
Pain Catastrophizing: What Practitioners Need to Know
Pain Therapy Options for the Home
Regenerative Medicine
The Future of Pain Management
Whole Body Vibration: Potential Benefits in the Management of Pain and Physical Function

The Future of Pain Management

Industry experts Jianguo Cheng, Stefan Evers, W. Clay Jackson, Lynn Kohan, William Maixner, Paula Marchetta, and more share their visions.
Pages 25-33
Page 4 of 6

In addition, better metrics are needed to document treatment outcomes. Two are suggested: the use of the Patient-Reported Outcomes Measurement Information System (PROMIS) combined with more objective socioeconomic outcomes (ie, return-to-work, medication and surgery rates, resolution of workers’ compensation and litigation claims); and subsequent decreases in healthcare utilization rates for the initial injury, which caused the pain in the first place.

In terms of other potential solutions, I recommend:

  • Promoting a major education campaign directed at insurance companies, as well as state and federal workers’ compensation boards, to demonstrate the positive outcomes of interdisciplinary pain management programs
  • Re-institute the importance of the Commission on Accreditation of Rehabilitation Facilities (CARF), but with more regular surveillance of those programs once they are accredited. In the past, CARF was viewed as a “Good Housekeeping stamp of approval” for pain management programs. Unfortunately, many CARF accredited programs “scammed” the system by having the full complement of interdisciplinary pain management personnel required during the CARF-accreditation process and visit, but then decreased the number of required personnel after accreditation, regressing back to single-modality pain clinics in order to save personnel costs. As a result, the outcomes from these diluted programs were poor, reinforcing many third-party payors’ perceptions of clinical ineffectiveness. Going forward, it must be demanded that, once accredited, CARF has routine, unannounced visits to programs to ensure compliance with the demands of true interdisciplinary pain management.
  • Develop reliable metrics related to “pay-for-performance.” There are two metrics that can be used for this purpose. The NIH invested approximately $60 million to develop PROMIS, which involves self-report measures that are often associated with chronic pain (eg, intensity, quality, interference, behavior, impact, physical function, depression, anxiety, fatigue, satisfaction with social roles, and sleep disturbance). PROMIS is psychometrically sound, and has been demonstrated to be both reliable and valid after large-scale testing. Moreover, the measures are anchored to a representative US population, and has a mean score of 50, and a standard deviation of 10. A statistical platform was developed to score and feed-back the results of patient-responses. These may be saved on a database that could be confidentially disclosed to document changes. 

Leonard B. Goldstein, DDS, PhD
Assistant VP, Clinical Education Development, AT Still University

While pain is a universal human experience, multiple changes are on the horizon. Each pain patient must take ownership of their pain and become an active participant in treatment. As time moves forward, we should see a much smaller dependence on pharmaceuticals, especially opioids, as they are replaced by non-addictive medications or combinations of non-opioids.

I predict growth in a few key areas: exercise and movement therapies (eg, yoga & Tai Chi); manual therapy (eg, manipulation by osteopathic physicians, chiropractors, and physical therapists); and behavioral/cognitive therapies such as mindfulness, CBD, and ACT. These treatments will likely be more utilized as part of a comprehensive, multimodal treatment plan, delivered by an interprofessional team of pain management experts from multiple specialties and philosophies. This approach may include other growing interventions as well, such as low-level laser therapy, biofeedback, qigong, and homeopathy.

National Pain Centers, Vernon Hills, IL

Over the next decade, the field of pain management will evolve drastically in ways that are different than the dramatic change we’ve seen over the past decade. Ten years ago, the pain care field was relatively unknown to the public and misunderstood within the medical profession. Today, pain management is either praised as a specialty that reverses torture or is chastised as a field that simply prescribes opioids and performs sham procedures.

Our ability to assess patients will likely be more entrenched in technology. With artificial intelligence and wearables becoming more integrated into our daily lives, we may find that our ability to assess patients will be dependent on this new technology. We will see improvements in interventional pain management options as well as medication options. I doubt we will see any resurgence in opioid-based pain management. Cannabis will be here to stay and, if not managed correctly, will serve up the next “epidemic.”

Communication between providers and patients will also change as telemedicine will not only become common, but will be expected by the majority of patients. It will seem relatively barbaric to have a patient take a half or full day off of work to see a physician in person to have a 15-minute-or-less discussion.

Training for physicians who specialize in pain management will continue to change and evolve. There will be a time when physicians who want to call themselves “pain management specialists” will actually have to complete an accredited residency and fellowship in pain management. The days of anyone prescribing pain medication or giving an injection and calling themselves a “pain expert” will be over.

Mary Lynn McPherson, PharmD, MA, MDE, BCPS, CPE
Pharmacy Practice and Science, University of Maryland School of Pharmacy

I wish I could predict where we’ll be in 5 to 10 years in pain management but, unfortunately, that’s not one of my superpowers! I can, however, offer my opinion on where I hope we’ll be in a decade or less... I strongly believe that practitioners today need to be as skilled at the clinical management of pain as they are in risk minimization. Patient assessment should include not only a thorough assessment of the pain complaint, but also screening for predictors of aberrant behavior with controlled substances. I hope that five years from now, the pendulum will have swung back to middle ground, and primary care once again will provide care to chronic pain patients.

Last updated on: February 20, 2019
Continue Reading:
Inflammation Targeted Nanomedicine