Why Balanced Pain Management Matters as Much as Ever

September 28, 2020

By Michael Leong, MD 

As a pain management specialist, I can see how the COVID-19 pandemic has disrupted patients’ access to treatments like targeted injections or physical therapy. The gap in care is a reminder of why a balanced, integrated approach to pain management is so important in the first place. 

That realization first took hold in the wake of the opioid crisis, when health care providers and patients clearly saw the need for a diversity of safe options to manage pain. Since then, pain management practices have embraced new, innovative methods to provide patients with the most focused and individualized care possible. My office at Stanford, for example, is pursuing a multidisciplinary approach.  

How does it work? Ideally, the various medical professionals engage with one another to tailor care for each patient. A multidisciplinary team-based approach might include a medical physician, pain psychologist, and physical therapist, who work together to find the best evidence-based treatment. 

If the providers can be under the same roof, that’s even better. This means a patient is not limited to seeing only one physician, or getting bounced around between different specialists.  

That experience has been too common for patients in pain, who, along the way, have been prescribed treatments that are ineffective, unsafe or simply incomplete for managing their pain.

Treatment options under a balanced approach to pain management are diverse. There are opioids but also non-opioid medications, including localized injections and pain treatments that come in spray or cream form. There are also a number of non-pharmacologic options like physical therapy, mindfulness techniques, or interventional pain management procedures. 

A more balanced approach to pain management had been gaining traction leading up to the pandemic. But its success hinges on the question of access. The COVID-19 crisis made that ever more complicated. 

Some patients who had stable pain management plans before the pandemic found themselves unable to continue with that regimen. While institutions across the country are beginning to reopen and start elective procedures such as epidurals or medial branch blocks with radiofrequency ablation, it is a slow and careful roll out. 

Physicians know that pain left untreated can be dangerous for patients.  It can lead to accidents or injury. It can lead to avoidable ER trips. It can also lead some patients, cut off from the pain treatments tailored to their needs, to look once again to opioids as the only available option.

As we resume normal life, we need to resume the effort to make a multidisciplinary approach widely accessible. COVID-19 has hurt our country in a variety of ways, but losing ground on pain management should not be another casualty of the coronavirus.  

From a policy perspective, this means implementing the HHS Pain Management Best Practices Interagency Task Force recommendations. The key barrier so far is funding. Unless private and government health plans offer appropriate coverage for all forms of pain management, opioids will continue to be the low-cost approach for too many patients. 

There is also work to be done on Capitol Hill and in the state legislatures to help more patients access care, especially alternative treatments like pain psychology or targeted neurotype therapies. The pain advocacy community will play a role. Meanwhile, patients shouldn’t be afraid to initiate a discussion with their physician about alternative treatments and therapies. 

There is strength in numbers. And with September being Pain Awareness Month, I can think of no better time for health care providers and patients to come forward and advocate as a united front for unfettered access to safe, effective and balanced pain management.

Michael Leong, MD, is a pain management specialist at Stanford University Division of Pain Medicine and a steering committee member of the Alliance for Balanced Pain Management.

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