The U.S. Department of Health and Human Services (HHS) Pain Management Best Practices Task Force convened its second public meeting on Sept. 25 and 26 in Washington, DC.
“The main purpose of the meeting was for the three task force subcommittees to present a high-level summary of their recommendations arrived at through working sessions held every week since the end of May,” says Cindy Steinberg, a task force member and U.S. Pain’s National Director of Policy and Advocacy. “Other goals were to hear input from high-level officials representing stakeholder government institutions, including HHS, Congress, the Centers for Medicare and Medicaid Services, the National Institutes of Health, the Department of Veterans Affairs, the Indian Health Service, and the Department of Defense. The task force also heard from the U.S. Surgeon General, patients living with chronic pain, and members of the public.”
Dr. Rollin Gallagher, emeritus pain physician at the Veterans Affairs’ Center for Health Equity Research and Promotion, presented a summary of the work of Subcommittee 1 on the topics of acute pain, medication, physical therapy and interventional procedures. In the area of acute pain, this subcommittee recommends using and improving reimbursement for a range of multimodal anesthesia techniques and non-opioid medications in the perioperative period (just before and after surgery) such as ultrasound guided nerve blocks and lidocaine and ketamine infusions to reduce pain and mitigate exposure to opioids. For chronic pain, when opioids are used, the type, duration and dosage of opioid therapy should be determined by the treating physician according to the individual’s needs and condition.
Highlights of Subcommittee 2’s recommendations were presented by Dr. Molly Rutherford, a primary care and addiction specialist at Bluegrass Family Wellness, on the topics of psychological interventions, risk assessment and stigma. To address barriers to psychological interventions for those living with chronic pain, providers should be trained in and reimbursed for the full range of behavioral treatments for managing pain, including cognitive behavioral therapy, coping skills, stress reduction, and mindfulness, among others. Risk assessment tools including urine toxicology screening and prescription monitoring programs, which should not be used punitively to discharge patients but instead should be used to better understand the patient’s challenges and to help redirect patients to effective strategies to manage their pain.
Subcommittee 3’s summary recommendations on complementary, alternative & integrative therapies, public, provider and patient Education and access to pain care were presented by Dr. Sherif Zaafron, President of the Texas Medical Board. The Task Force recommends that a broad spectrum of complementary, alternative and integrative therapies be used in the treatment of acute and chronic pain, while additional research be conducted to determine therapeutic value for particular pain conditions and syndromes, risks and benefits, and mechanisms of action. A national pain awareness campaign to advance the public’s understanding of acute and chronic pain is recommended. Patient education is recognized as an important and necessary best practice with the recommendation that a national panel of chronic pain patients, patient advocates, and clinicians be convened to develop a set of core competencies for patient education, and that government grants be provided for the creation of of patient education programs based on these core competencies and disseminated widely to patients and their families.
The task force voted to accept the full body of draft recommendations, which are much more extensive than the highlights provided. Dr. Vanila Singh, Task Force Chair and Chief Medical Officer for the HHS Office of the Assistant Secretary for Health, said that next steps are to complete the narrative report supporting the recommendations by the end of October, which will be followed by a 90-day public comment period.