Abstract ID: 3886

Primary Topic: Integrative medicine delivery models
Secondary Topic: Health Services Research/Cost Effectiveness

Changing the Pain Care Paradigm: Essential Actions for Moving Beyond Medications
Margaret A. Chesney, PhD; Leonard Wisneski, MD, , Denver, CO, United States; Robert Twillman, PhD, AIPM, Lawrence, KS, United States; Alison M. Whitehead, MPH, , Washington, DC, United States; David O’Bryon, JD, Academic Collaborative for Integrative Health, Bethesda, MD, United States

Late Breaker: No

Overview

New guidelines, regulations and legislation are nearly universal in recommending that first-line treatment for pain should focus on non-pharmacological treatments. Very few recognize the existing challenges inherent in following those recommendations. Many of these recommendations lack details about which treatments should be pursued for which patients.  Other access challenges include, but are not limited to: inadequately educated providers, regarding how to optimally assess and refer people with pain; lack of central resources where professionals with non-pharmacological expertise can be identified as referral providers; a paucity of providers available in some, particularly rural, areas; and inadequate insurance coverage leaving people with pain paying out of pocket for care, something many find challenging.

This panel discussion, chaired by Margaret Chesney, Past Chair of the Consortium, will introduce these barriers and challenges to implementing the recommendations for non-pharmacological pain treatments and the pressing need to address them. Bob Twillman, Executive Director of the Academy of Integrative Pain Management, will discuss efforts aimed at helping providers assess patients with pain with an eye toward developing patient-centered care plans that include appropriate non-pharmacological treatments. David O’Bryon, Chair of the Academic Collaborative for Integrative Health, will follow with examples of professions, including acupuncture and chiropractic, which engage in educational and outreach efforts to clinical providers to convey the benefits of non-pharmacological treatments, a first step in developing referral resources.  Alison Whitehead, the Consortium’s Policy Working Group’s Chairperson, will discuss the VA’s Patient-Centered Care and Cultural Transformation Program, and highlight lessons learned regarding incorporation of non-pharmacological treatments into that program. Finally, Len Wisneski, Chair of the Integrative Health Policy Consortium, will review the outcomes of the recent Pain Care Policy Forum, a meeting that involved professional organizations, pain patient advocacy organizations, and third-party payers, with a focus on improving insurance coverage for non-pharmacological treatments.

Rationale

 

While the new guidelines calling for non-pharmacological approaches to pain are a major advance for integrative medicine and health, there are many challenges that need to be met in order for these strategies to be adopted widely into healthcare.  It is important that these challenges be met before the current attention to this issue fades and new pharmacological approaches for pain management are introduced. The Consortium and other integrative health organizations are taking steps to communicate what is known about the evidence-base for integrative approaches. This panel discussion will focus on the critical next steps needed to translate that evidence in to action with a focus on education, access, and coverage. 

Educational efforts need to be directed to both health care providers and the public about non-pharmacological treatment options, including the evidence base as well such details as expectations regarding frequency, dosing and shared responsibility.

Access in the context of this panel discussion will involve not only patients’ access to non-pharmacological care, but clinicians’ access to a resource or system to facilitate referring patients to experienced practitioners who can provide non-pharmacological pain care.

Coverage for non-pharmacological care is lacking despite the recommendations coming from the National Academy of Medicine, FDA, Joint Commission, and many other organizations. This panel discussion will present steps that are being taken to advance efforts to improve insurance coverage in today’s volatile heath care environment.

Objectives

As a result of this panel discussion, attendees will:

  1. Understand the challenges that must be overcome in order for non-pharmacological treatment to be widely utilized as the first-line treatment for pain.
  2. Recognize the importance of assessing patients with the goal of developing patient-centered care plans that include appropriate non-pharmacological treatments for pain.
  3. Appreciate the need to create systems to facilitate referrals by clinical providers to professionals experienced in non-pharmacologic treatments for pain.

Methods/Session Format

  1. Dr. Margaret Chesney will present an overview of the barriers to implementing non-pharmacological pain treatments (8 minutes)
  2. Dr. Robert Twillman will discuss the need for and efforts underway to educate providers to carry out pain assessments which lead to patient-centered care plans for non-pharmacological treatments for pain (12 minutes)
  3. Dr. David O’Bryon will describe examples from several professions, including acupuncture and chiropractic, which reach out to clinical providers, convey the benefits of non-pharmacological treatments - a first step toward developing referral resources. (10 minutes)
  4. Ms. Alison Whitehead will discuss the VA’s Patient-Centered Care and Cultural Transformation Program, and highlight lessons learned regarding incorporation of non-pharmacological treatments into that program. (10 minutes)
  5. Leonard Wisneski will review the outcomes from the Pain Care Policy Forum, a meeting that involved professional organizations, pain patient advocacy organizations, and third-party payers, with a focus on improving insurance coverage for non-pharmacological treatments. (10 minutes)
  6. Question and answer session between panelists and panel moderated by the chair.
    (10 minutes)

Outline

  1. There are barriers and challenges to implementing the recommendations for non-pharmacological pain treatments and a pressing need to address them.
  2. Specific challenges to implementation include inadequate education for providers and the public about non-pharmacological approaches, a lack of resources where experienced professionals with non-pharmacological expertise can be identified for referrals, availability of providers on some rural areas, and inadequate insurance coverage.
  3. Efforts are underway to help providers assess pain patients and develop patient-centered care plans that include non-pharmacological treatments.
  4. There are examples from several professions, including acupuncture and chiropractic, which are reaching out to clinicians, conveying the benefit of non-pharmacological treatments - a first step toward developing referral resources.
  5. The VA’s Patient-Centered Care and Cultural Transformation Program provides lessons learned regarding incorporation of non-pharmacological treatments into pain management.
  6. Professional organizations, advocacy organizations, and third-party payers are making efforts to improve insurance coverage for non-pharmacological treatments for pain.