HHS Proposes National Strategy for Pain Management

Last month, the Office of the Assistant Secretary for Health at Department of Health and Human (HHS) Service released the National Pain Strategy, the federal government’s first coordinated plan for reducing the burden of chronic pain that affects millions of Americans.

David Gitlin, M.D.

“This report identifies the key steps we can take to improve how we prevent, assess, and treat pain in this country,” Karen DeSalvo, M.D., M.P.H., M.Sc., HHS acting assistant secretary for health said in a press release.

Chronic pain, which in some cases can arise from injury, infection, or disease is estimated to affect approximately 100 million U.S. adults at a cost of $560 to $635 billion.

“It has been acknowledged by most national medical organizations that pain is one of the more complicated and important conditions we face in medicine,” said David Gitlin, M.D., chief of the Division of Medical Psychiatry at the Brigham and Women’s Faulker Hospital and chair of the APA Council on Psychosomatic Medicine. “For many years pain was frequently missed or undertreated in many patients,” he told Psychiatric News.

Over the past 20 years, Gitlin said the medical community has made marked improvements in the way it assesses and treats pain; however, he added, some of these changes may have contributed to “a significant increase in the use of opioid medications, which has contributed significantly to the current opioid crisis nationally.”

The National Pain Strategy makes several recommendations for improving pain care in six key areas:

• Population research: Refine and employ standardized health care data methods to determine the extent to which people with common pain conditions receive various treatments and services, the costs of these services, and the extent of use of treatments; and develop a system of metrics for tracking changes in pain prevalence, impact, treatment, and costs over time.

• Prevention and care: Characterize the benefits and costs of current prevention and treatment approaches thorough benefit-to-cost analysis. Promote alternative pain treatments outside of opioid painkillers (e.g., cognitive-behavioral therapy and acupuncture) and develop new interventions that will combine the biopsychosocial elements of patients, including self-management pain programs.

• Disparities: Improve the quality and availability of data to assess the costs of disparities in pain care. Work to understand the negative impact of biases on pain treatment and develop strategies to overcome such biases.

• Service delivery and payment: Tailor payment to promote and incentivize high-quality, coordinated pain care through an integrated biopsychosocial approach that is cost-effective, value-based, patient-centered, comprehensive, and improves outcomes for people with pain.

• Professional education and training: Develop, review, and regularly update core competencies for pain care education and licensure and certification at the undergraduate and graduate levels. Efforts to enhance health care provider knowledge and skills for safer prescribing practices and identify risks for opioid use disorder should be coordinated with ongoing activities across HHS.

• Public education and communication: Develop and implement a national educational campaign about the impact and seriousness of chronic pain and promote safer use of all medications, especially opioids, among patients with pain.

“Patient and provider education as well as alternative treatments for pain are great issues to address,” Gitlin said of the report.

He added, “Opioid medications will likely continue to be a critical component of treatment for some patients, and thus there will always be a subgroup of patients who will develop comorbid opioid use disorders, especially those who have demonstrated previous vulnerability. The goal of recognizing and responding effectively to the opiate use crisis needs to remain central to the overall strategy.” ■