A federal advisory group has released a draft version of its National Pain Strategy, which seeks to redefine the way pain is perceived and treated in the U.S.
The report was written by the Interagency Pain Research Coordinating Committee (IPRCC), which is comprised of representation from the FDA, the NIH, the CDC, the Agency for Healthcare Research and Quality (AHRQ), the Department of Defense, and the Department of Veterans Affairs.
It involved six working groups that tackled various aspects of pain care: population research, prevention and care, disparities, service delivery and reimbursement, professional education and training, and public awareness. The strategy is the result of a mandate in the 2010 Affordable Care Act, which asked the Department of Health and Human Services to "increase the recognition of pain as a significant public health problem."
According to strategy co-chair Sean Mackey, MD, PhD of Stanford, "It's not meant to dive into the weeds and recommend specific therapies. It's meant to offer recommendations on how we can change the way we care for patients and incentivize that treatment."
The report discusses gaps in primary care physicians' understanding of pain and how to treat it, since these professionals are often on the front lines of care, and emphasizes that patients need to be more involved in decision-making about their care.
The report acknowledges that more liberal prescribing of the drug class has led to a rise in addiction, abuse, and overdose, but it maintains that the drugs are considered medically appropriate for acute and intractable pain that doesn't respond to other therapies.
Still, it notes that there aren't enough data to help tell which patients are candidates for opioid therapy, on appropriate dosing strategies, or on risk mitigation, and there's a need for further research on the safety and efficacy of long-term opioids for chronic pain.
It’s time to put the Hamburg Manifesto (former FDA Commissioner’s Peggy Hamburg’s pain policy legacy) – which calls for a more robust and regular focus on physician education to the front the pain agenda. It’s also an opportunity for the members of the pain policy ecosystem (manufacturers, physicians, medical schools, CME organizations, social scientists, patient organizations, and regulators) to work together to develop validated methodologies for determining which opioid-appropriate patients are at risk for addictive behavior.
Further, it's time to understand that for differing pain mechanisms there are appropriate non-opioid treatments which most often are bypassed due to cost and access barriers from payers or a need for a quick fix by an overwhelmed physician. Attention must be paid.
In a world driven by social media and ever-more sophisticated e-tools such as mobile apps, it’s time to make smart education a priority. Forewarned is Forearmed.
