Physicians treating patients with acute pain should focus on using a multimodal approach that includes medications, nerve blocks, physical therapy and other modalities, according to a federal task force's final report on acute and chronic pain management best practices (PDF) released Thursday.
At the same time, doctors treating patients with chronic pain should look to a multidisciplinary approach across various fields. That could include medications, restorative therapies like physical therapy, cognitive therapies and complementary or integrative health.
Those are among a number of final conclusions aimed at more "individualized, patient-centered" care for pain patients included in a final report by the 29-member Pain Management Best Practices Inter-Agency Task Force. The aim of the report was to offer guidance for physicians seeking to appropriately address pain among their patients while attempting to curb the number of opioids prescribed.
The report emphasizes the development of an effective pain treatment plan after proper evaluation to establish a diagnosis with measurable outcomes that focus on improvements including quality of life, functionality and activities of daily living.
Among gaps and recommendations highlighted in the report, the task force said:
- Comprehensive screening and risk assessment are time-consuming but vital. Physicians are also not sufficiently compensated for screening. The report calls for encouraging the Centers for Medicare & Medicaid Services to provide adequate compensation and for physicians to consider referring high-risk patients to pain, mental health and other specialists, including addiction medicine-trained physicians when high-risk patients are identified.
- There are inconsistencies and fragmentation of pain care services, the report said. The task force recommends a coherent policy for pain management for all relevant stakeholders and encouragement that providers' use of the guidelines is informed by evidence and created by specialty organizations and associations that are experts in the treatment of certain pain conditions.
- Multimodal, non-opioid therapies are underutilized in the perioperative, inflammatory, musculoskeletal and neuropathic injury settings. The report recommends providers use procedure-specific, multimodal regimens and therapies when indicated in the perioperative period, including various non-opioid medications, ultrasound-guided nerve blocks, analgesia techniques and psychological and integrative therapies to mitigate opioid exposure.
The task force, which was convened as part of the Comprehensive Addiction and Recovery Act of 2016, includes providers, patients and government employees. It’s spearheaded by the Department of Health and Human Services with cooperation from the departments of Defense and Veterans Affairs.
The report noted that chronic pain is a widespread problem in the U.S., impacting 50 million adults, or 20% of that population. Of those, an estimated 19.6 million experience “high-impact” pain that interferes with daily life and work activities. That raises the stakes on finding alternatives, according to the task force.
In April, the Centers for Disease Control and Prevention (CDC) clarified a controversial federal guideline for prescribing opioids that it issued three years ago in the face of the opioid epidemic sweeping the country. In a letter (PDF) released publicly, the CDC said the guidelines were not intended to deny chronic pain patients access to opioids and encouraged physicians to use their “clinical judgment” in prescribing the medications, which can be addictive. The task force report reiterated that message.