Barriers to the provision of nonpharmacologic therapies in particular include coverage that is absent or inadequate, unreceptive attitudes of HCPs and patients, and shortages of pain and behavioral healthcare specialists. 30 An Inter-agency Task Force convened by the Department of Health and Human Services (HHS) to recommend best practices in pain care proposed several ways of addressing gaps: 3 ● Create clinical practice guidelines to better incorporate evidence-based complementary and integrative therapies into practice. ● Improve insurance coverage and payment for different modalities on the basis of the best practices identified in new guidelines. ● Improve coverage and payment for multidisciplinary team care coordination. ● Expand access to treatment and geographical coverage via the use of telemedicine and other technological delivery methods for psychological and behavioral health interventions. ● Increase the number and training of qualified practitioners in behavioral health and other Treatment options for managing pain The HHS Inter-Agency Task Force on best practices in pain management categorizes options for pain treatment as medication, restorative, interventional, behavioral health, and complementary and integrative. 3 Medications include opioid and Nonpharmacologic options for pain A number of evidence-based nonpharmacologic treatments are recommended, either used alone or in combination with other modalities within a treatment plan that is individualized and draws from multiple disciplines (Table 1). 3,32,33 Nonpharmacologic options should not be considered “alternatives” to opioids but are encouraged as part of a comprehensive pain plan in keeping with the evidence base, patient access to competent practitioners, and adequate insurance coverage and reimbursement.
evidence-based complementary and integrative disciplines. ● Provide better education as well as time and financial support for primary care practitioners who give patients the sole available pain care in many parts of the country. Another barrier to pain care is the stigma in living with chronic pain, which is often cited by patients and their caregivers as a difficulty worsened by lack of objective biomarkers for pain, the invisible nature of the disease, and societal attitudes that equate acknowledging pain with weakness. 31 Compassion, empathy, and trust within a practitioner-patient relationship are key to navigating these challenges. It can help to offer education to the patient regarding the underlying disease processes of pain and to encourage them to seek help early for pain that persists beyond the expected time frame. When opioids are indicated, it is strategic to counsel patients that opioids are an appropriate part of their pain treatment plan so that the stigma of the societal opioid crisis does not interfere with appropriate treatment and good outcomes for the patient regarding opioid use. 23 nonopioid pharmacologic treatments. What follows are examples of each (not an exhaustive list) and a brief discussion of the evidence base underpinning these options. Frequently covered modalities for chronic pain include cognitive behavioral therapy (CBT), physical therapy, certain injections, exercise, and electrical stimulation. 32 Patients may find it helpful to combine approaches that include nutritional support, healthy lifestyle changes, patient education, sleep hygiene instruction, and relaxation and visualization techniques. The noninvasive nature and low side effect profile of nonpharmacologic treatments suggest they should be used first and preferentially.
Table 1. Noninvasive, Nonpharmacologic Approaches to Pain Management 3 Restorative Behavioral Health
Complementary and Integrative • Acupuncture • Massage, manipulative therapies • Mindfulness-based stress reduction • Spirituality • Tai chi
• Physical therapy • Occupational therapy • Physiotherapy • Therapeutic exercise • Transcutaneous electric nerve stimulation • Massage therapy • Traction • Cold and heat • Therapeutic ultrasound • Bracing • Chiropracty
• Cognitive behavioral therapy • Acceptance and commitment therapy • Mindfulness-based stress reduction • Emotional awareness and expression therapy • Self-regulatory/ psychophysiological approaches: ○ Biofeedback ○ Relaxation training ○ Hypnotherapy
• Yoga • Reiki
Book Code: MDCO1025
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