New Pain Management Strategies Spelled Out

November 15, 2017

National initiatives are designed to provide education, advance research, solve the opioid crisis, and help patients.

In light of the opioid crisis, the Federal Government has developed new strategies for pain management. The rationale for the National Pain Strategy and related research was explained, and how these new strategies are being implemented was clarified, in a November 7 presentation at the ACR/ARHP Annual Meeting in San Diego.

Implementing the 2016 National Pain Strategy
Dr Vanila M. Singh, Chief Medical Officer of the Office of the Assistant Secretary of Health, launched the discussion of the National Pain Strategy, the government’s first broad-ranging effort to improve how pain is perceived, assessed, and treated. The Federal Government considers this strategy a significant step toward the ideal state of pain care.

The National Pain Strategy’s goal is to address 6 areas: (1) disparities, (2) prevention and care, (3) service delivery and payment, (4) professional education and training, (5) public education and communication, and (6) population research.

Dr Singh discussed some of the National Pain Strategy’s deliverables. For example, to advance service delivery and payment, the Agency for Healthcare Research and Quality is conducting a systematic review on nonpharmacological treatments for pain. To advance professional education, the NIH has developed the Centers of Excellence in Pain Education and created an online pain education portal.

Dr Singh concluded by reviewing the directive of the Pain Management Task Force, which was congressionally mandated by the Comprehensive Addiction and Recovery Act of 2016. The task force includes federal and non-federal partners, including prescribers, pharmacists, pertinent medical organizations, veterans’ organizations, first responders, and patient advocacy groups. The task force’s goal will be to provide best practice guidelines for patients who have acute and chronic pain.

The Federal Pain Research Strategy
Linda Porter, PhD, Director of the Office of Pain Policy at NIH, shared federal research initiatives related to improving what is known about pain and how to manage it. Under the auspices of the Interagency Pain Research Coordinating Committee and the NIH, scientific experts, patient advocates, and federal representatives have collaborated to identify and prioritize research recommendations.

The top research priorities include understanding plasticity mechanisms that promote persistent pain and resolution mechanisms, determining mechanisms that sustain or resolve chronic pain, and determining optimal safe and effective chronic pain management. Overall, the Federal Pain Research Strategy provides guidance for federal agencies and departments that support pain research.
Funding to research the transition from acute pain to chronic pain has been requested under the “common fund,” one dedicated to big projects that are condition-neutral but too big to have one institute likely to be able to fund it. Research partnerships are also being developed to address the opioid crisis as well as the challenges associated with developing nonaddictive pain medications.

Pain and opioids
The session concluded with a presentation from Dr Charles G. Helmick, medical epidemiologist with the Arthritis Program at the National Center for Chronic Disease Prevention and Health Promotion, a part of the CDC. Dr Helmick focused on the growing momentum in addressing pain management and opioid use.

Among US adults in 2012, 25.3 million (11.2%) had daily pain, 23.4 million (10.3%) had a lot of pain, and 14.4 million (6%) had severe pain, and the current pain management system clearly is not working well enough for these persons, he noted. However, increasing fatalities from opioid use are affecting all demographics and opioid abuse often starts with a valid prescription.

Dr Helmick provided 2 examples of momentum in addressing these issues. One, an initiative called Healthy People 2020, has 4 developmental objectives for pain: (1) decrease the prevalence of adults having high-impact chronic pain, (2) increase public awareness of high-impact chronic pain, (3) increase self-management of high-impact chronic pain, and (4) reduce the effects of high-impact chronic pain on family and significant others.

Rheumatic and musculoskeletal diseases are particularly relevant to this initiative because they are common causes of pain and poor function. More than 50% of adults for whom opioids are prescribed have arthritis.

Momentum also comes from the 2016 National Health Interview Survey, which included 2 questions to gather additional data about the prevalence of chronic pain. The questions will be included in 2017, and additional questions about work limitations, impact on family, and self-management are under consideration. Better understanding of the prevalence of chronic pain may allow for the development of more useful strategies to address pain.

Conclusions
The presenters concluded that the National Pain Strategy, Federal Pain Research Strategy, and related initiatives are striving to educate health care providers, advance research, develop solutions to the opioid crisis, and provide better pain management for patients.

References:

5T120 ARHP: National Strategies for Addressing Pain. Presented at: 2017 ACR/ARHP Annual Meeting. November 3-8, 2017. San Diego, California.