Institute for Patient Access

December 8, 2016

There’s no way to address America’s prescription drug abuse crisis without balanced pain management, explained the National Institutes of Health’s Linda Porter, PhD, at Tuesday’s Summit on Balanced Pain Management. But clearing the way for integrated care won’t be easy – as the day-long event’s broad range of patient advocates, health care providers, researchers and government representatives made clear.

The National Pain Strategy

In “A Conversation with the NIH,” David Thomas, PhD, and Linda Porter, PhD, outlined the vision of the National Pain Strategy. The document offers steps toward realizing a much-needed cultural shift in pain treatment. It reflects the input of six federal agencies and 80 experts from across the medical, advocacy, patient and scientific communities. Among its six key areas is the need for access to multidisciplinary care.

Dr. Thomas remarked on how little training most physicians receive about treating pain – typically nine hours out of their four years in medical school. As a result, many patients are receiving opioids who would benefit from a different approach. “Opioids are not a replacement for comprehensive pain treatment,” Dr. Thomas explained.

In a separate presentation, Thomas Novotny, MD, outlined the Department of Health and Human Services’ Healthy People 2020 targets for implementing the National Pain Strategy. The goal, he explained, is “balancing access to pain treatment with reducing health harms from inappropriate opioid use.”

Balanced Pain Management in Practice

Patient education and access are also important, as the summit’s “Balanced Pain Management in Practice” panel made clear.

Penney Cowan of the American Chronic Pain Association noted that patients should be told to always expect some element of pain. Her message to physicians and patients alike: “Talk about balanced pain management every chance you get.”
Sara Bertoch of the Brooks Rehabilitation Hospital described the impressive outcomes she’s seen in facilities that use balanced pain management. One five-week program requires at least three hours of physical therapy a day, along with occupational therapy, weekly physician oversight and psychological counseling.
Vern Saboe of the Oregon Chiropractic Association echoed the sentiment, describing patients who had avoided surgery and expensive MRIs by receiving chiropractic and complementary care.

But access to such treatments is complicated. Bob Twillman, PhD, of the Academy of Integrative Pain Management elaborated on coverage challenges in his summit address. Achieving access to balanced pain management is an “aspirational goal” for right now, Dr. Twillman noted. He explored a number of access barriers, including:

The need for more trained anesthesiologists and staff who care for patients after surgery
Restrictive formularies that block access to medications due to cost
Other utilization management techniques such as cost sharing, prior authorization, step therapy and coverage limitations.

Cutting through these barriers is crucial, Dr. Twillman explained, as a balanced approach can “speed recovery, shorten hospital stays, reduce opioid use, and reduce complications” for patients.

Safe Use and Disposal

Education efforts must also extend to the safe use and disposal of prescription drugs, another panel explained.

Shaina Smith of the U.S. Pain Foundation emphasized the need for more communication and education on issues such as the interaction and safe use of over-the-counter medications.
Daniel Cohen of the Abuse Deterrent Coalition noted the need for better education on the role of abuse-deterrent opioid formulations, which resist crushing or dissolving for recreational use. “They’re not for addict; they’re not for patients,” he explained, “What they do is serve the public health benefit.”
Judi Lund Person of the National Hospice and Palliative Care Organization addressed the need for safe use among patients at end of life, where issues like addiction and abuse are less pertinent.
Lisa McElhaney of the National Association of Drug Diversion Investigators outlined the value of prescription drug monitoring programs as sources of information to inform prescriber’s decisions and to provide records of patients’ treatment over time. But, the “ultimate decision is up to the prescriber,” she noted.

Overcoming Prescription Drug Addiction & Abuse

The summit also explored the needs of patients struggling with prescription opioid abuse and addiction. Rep. Larry Bucshon, MD, (R-Ind.) a former heart surgeon who now serves on the Energy & Commerce Committee’s Health Subcommittee, noted the progress made by Congress with the recent passage of the Comprehensive Addiction and Recovery Act. He described it as “a start” in addressing the nation’s pressing opioid addiction problem. He also echoed earlier speakers’ emphasis on the need for more formal training for physicians on how to treat pain.

The event’s keynote speaker, former NFL quarterback Ryan Leaf, put a personal face to the issue of pain treatment and abuse. He shared his decade-long struggle with prescription opioid addiction, which led to arrest, incarceration and suicide attempts – but ultimately redemption. He praised the work of the Alliance for Balanced Pain Management in trying to ensure safe, personalized options for patients and emphasized the need for young athletes to ask for help. “”I don’t want people who are going through what I did to feel as miserable as I did,” he explained.

For related materials, see:

Social media coverage of the Alliance on Balanced Pain Management

VIDEO: Understanding Balanced Pain Management

A Call for Understanding and Greater Access to Balanced Pain Management

Addressing America’s Pain & Opioid Addiction Problems