September is Pain Awareness Month in the United States. The CHP Group will be sharing tools and resources this month related to pain awareness and pain management from the International Association for the Study of Pain and other sources. The information below has been highlighted from the Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, INconsistencies, and Recommendations, published by the US Department of Health and Human Services at https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf. The U.S. Department of Health and Human Services oversaw this report with the U.S. Department of Veterans Affairs and U.S. Department of Defense.
Patients with acute and chronic pain in the United States face a crisis because of significant challenges in obtaining adequate care, resulting in profound physical, emotional, and societal costs. According to the Centers for Disease Control and Prevention, 50 million adults in the United States have chronic daily pain, with 19.6 million adults experiencing high-impact chronic pain that interferes with daily life or work activities.
The cost of pain to our nation is estimated at between $560 billion and $635 billion annually. At the same time, our nation is facing an opioid crisis that, over the past two decades, has resulted in an unprecedented wave of overdose deaths associated with prescription opioids, heroin, and synthetic opioids.
The current opioid crisis has spurred intense interest in identifying effective nonpharmacologic approaches to managing pain. The use of complementary and integrative health approaches for pain has grown within care settings across the United States over the past decades.
As with other treatment modalities, complementary and integrative health approaches can be used as stand-alone interventions or as part of a multidisciplinary approach, as clinically indicated and based on patient status. Examples of complementary and integrative health approaches to pain include acupuncture, hands-on manipulative techniques (e.g., osteopathic or chiropractic manipulation, massage therapy), mindfulness, yoga, tai chi, biofeedback, art and music therapy, spirituality, and the use of natural or nutritional supplements.
These therapies can be provided or overseen by licensed professionals and trained instructors. The use of complementary and integrative health approaches should be communicated to the pain management team.
Overall, most complementary and integrative health approaches can provide improved relief, when clinically indicated, when used alone or in combination with conventional therapies such as medications, behavioral therapies, and interventional treatments, although more research to develop evidence-informed treatment guidelines is needed.1Tick H, Nielsen A, Pelletier KR, et al. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore N Y N. 2018;14(3):177-211. doi:10.1016/j. explore.2018.02.001
Improved reimbursement policies for complementary and integrative health approaches as well as improved education for medical professionals and a greater workforce of pain management specialists can address key barriers to acceptance and implementation of complementary and integrative health approaches for pain.2ibid
Additional research, greater patient and clinician education — including clinical guidance and indications for use — and expanded coverage of complementary and integrative health approaches are essential for a comprehensive solution to reduce the reliance on opioids.