Access to Pain Care Poses Policy Challenges

“As we deal with the opioid crisis, we must keep in mind those Americans who are hurting.”  

These words, from Sen. Lamar Alexander (R-Tenn.) during a February Senate hearing, underscore an issue that continues to dog policy efforts on opioid addiction: Are policy changes helping – or hurting – Americans in pain?  The issue surfaced again this week.

CDC Guidelines Clarification

More than 300 academics, physicians, patients and advocates petitioned the Centers for Disease Control and Prevention on Wednesday to clarify their 2016 guidelines on opioid prescribing.  The guidelines encourage physicians to limit the duration of opioid prescriptions for new patients and to encourage tapering for patients already on an opioid regimen.

But that advice has been interpreted as a mandate, even becoming law in some states.  For instance, the guidelines suggest that new opioid prescriptions should not exceed 90 milligrams per day.  Some states, physicians and health plans interpreted that dosage as a threshold – even for chronic pain patients accustomated to a higher prescribed dosage to manage their pain.  

Citing “widespread misapplication” of the CDC’s guidelines, the experts’ letter describes the domino effect that followed.  Health insurers introduced coverage barriers, physicians feared legal consequences, states enacted laws and chronic pain patients faced agonizing withdrawal – leading some to illicit alternatives to address their pain, or even suicide.

The letter cites the CDC’s “moral imperative” to protect patients and urges the agency to issue clarification.

Congressional Hearing on Pain

But there is some good news.  Policymakers are receptive to the needs of patients in pain, and they are pursing policies to improve access to comprehensive, integrated care.

The issue is a priority for the 116th Congress, for example.  The Senate Health Committee welcomed testimony from health care providers and advocates during its February 12 hearing on pain management.  That included Cindy Steinberg, a chronic pain patient and advocate with the U.S. Pain Foundation, who reiterated patients’ need for “new, effective, and safer options.”

Inter-Agency Task Force Report

Meanwhile, the Pain Management Best Practices Inter-Agency Task Force described the need for non-addictive pain treatments in its recent draft report.  The task force is a collaboration of the Department of Health and Human Services, the Department of Veterans Affairs, the Department of Defense and the Office of National Drug Control Policy.  Its report focuses on gaps, inconsistencies and recommendations in pain management.

The report drew praise from advocacy organizations such as the Alliance for Balanced Pain Management, which applauded the task force for acknowledging the need for research on “innovative modes of delivery and treatment” for pain.  The alliance also echoed the task force’s observation that “patients with complex and persistent pain often experience barriers to care,” noting this is particularly true for non-pharmacologic and behavioral health interventions.

The Alliance for Balanced Pain Management explored these and related issues in a 2018 white paper, which argues that stronger coverage policies can expand access to non-opioid pain management practices.  These could include technology-based solutions like continuous peripheral nerve blocks or non-pharmacologic treatments like physical therapy and yoga.

Policymakers face the intersecting challenges of addressing opioid abuse, improving access to balanced pain management and meeting the health care needs of patients in pain.  The task is formidable. But patients and advocates remain hopeful that heightened focus on the issue will translate to real, timely solutions.


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