The Role of Nonpharmacological Approaches to Pain Management Proceedings of a Workshop (2019) / Chapter Skim
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7 Policies to Address Barriers to the Use of Evidence-Based Nonpharmacological Approaches to Pain Management
7 Policies to Address Barriers to the Use of Evidence-Based Nonpharmacological Approaches to Pain Management
Pages 63-76
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From page 63... ...
. • Flexible policies are needed that allow providers to deliver the right treatments to the right people, and that equip people to self manage their pain as much as possible without demonizing the need to receive medical treatment, including opioids when appro priate (Darnall)
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From page 64... ...
Chapter 6 discussed efforts to address the problem of inadequate pain education through the development of interprofessional curricula. However, inadequate education is but one of many barriers to the delivery of effective pain care (Kligler et al., 2018)
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From page 65... ...
CHOIR allows providers to track multidimensional aspects of a patient's pain over time, discuss with patients which symptoms have the most impact, and then engage them in different dimensions of treatment. For example, Darnall and her colleagues have developed a perioperative digital behavioral pain medicine treatment called My Surgical Success to help patients learn how to self-manage pain after surgery.
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From page 66... ...
The need for changes in pain education was reiterated by Carr as well as Penney Cowan, founder and chief executive officer of the American Chronic Pain Association. Cowan called for mandatory education in pain management for all health care providers across the board.
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. Reforming Reimbursement Policies Discordance between evidence-based best practices and payment structures, such as inadequate coverage for multidisciplinary therapy including behavioral therapy and medication-assisted therapy, further hinder delivery of optimal pain care, said Carr.
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Implementing Integrative Pain Management Harley Goldberg, retired physician executive at the Northern California Kaiser Permanente Medical Care Program, shared experiences he had when implementing complementary approaches in a closed health care system that combines both delivery of and payment for services. Evidence of the efficacy of acupuncture did not drive inclusion of the modality into the system, he said.
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From page 69... ...
Lisi added that chiropractic users in the VA tend to be younger and more likely to be female, which matches the priority population of Iraq and Afghanistan veterans who, in comparison with veterans of previous wars, are also younger, more likely to be female, and more likely to have chronic musculoskeletal pain and mental illness as their main complaints. In 2016, the VA Health Services Research & Development Service held a state-of-the-art conference on nonpharmacological approaches for the management of chronic musculoskeletal pain.
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From page 70... ...
Providers need to be educated about the value of providing nonpharmacological treatments early, Heapy added. THE PAYER PERSPECTIVE: INSURANCE COVERAGE AND REIMBURSEMENT With public attention focused on both the opioid epidemic and the care of people in pain, policy makers have the unique opportunity to scrutinize the role coverage and reimbursement policies can play in reducing the overuse of opioids and improving quality of care for those in pain, said
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From page 71... ...
Strengthening coverage, reimbursement, quality, and access to nonpharmacological treatments is the place to start, he said. Eight years ago, DoD published a report that concluded there was good evidence for the use of many nonpharmacological modalities, especially yoga, massage therapy, mindfulness meditation, and tai chi for back pain, in contrast to the use of chronic opioids and highly invasive and potentially destructive surgical approaches, said Eric Schoomaker (Office of the Army Surgeon General, 2010)
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From page 72... ...
Other challenges raised by this policy include workforce issues such as licensing and credentialing; educating providers, patients, and plan medical directors; and implementation issues related to meeting requirements and tapering opioids, said Livingston. In Chapter 2, David Elton said that when the first point of contact is a chiropractor or physical therapist, opioid use is markedly reduced and suggested that substantial savings could be realized if physical therapists and chiropractors replaced primary care providers or specialists as first line providers.
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From page 73... ...
Providing consumers with tools and resources to help them understand available options based on the characteristics of their pain and their own personal preferences could help guide them toward choosing conservative care when appropriate, or more aggressive care when needed, he said. Reforming Reimbursement Policies Value-based payment reforms through shared savings or bundling may address another barrier to the delivery of quality pain care (i.e., the
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, added that the CMS Innovation Center has also developed several bundled payment care initiative models and is exploring other alternative payment models as well, although no pain-specific model thus far. One possible approach would combine comprehensive primary care with an alternative payment model, she said.
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all need to be standardized and aligned. She noted that this is already taking place as a result of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act)
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