The Pain Management Best Practices Inter-Agency Task Force, a federal advisory committee established by the Comprehensive Addiction and Recovery Act of 2016, released its final report on acute and chronic pain management best practices, calling for a balanced, individualized, patient-centered approach. The Task Force has 29 members, representing federal and non-federal entities with diverse disciplines and views, and is overseen by the Department of Health and Human Services.
To ensure best practices for the treatment of pain, the Task Force final report underscores the need to address stigma, risk assessment, access to care and education. It also highlights five broad categories for pain treatment: medications, interventional procedures, restorative therapies, behavioral health, and complementary and integrative health approaches.
“There is a no one-size-fits-all approach when treating and managing patients with painful conditions,” said Vanila M. Singh, Task Force chair, and chief medical officer of the HHS Office of the Assistant Secretary for Health, in a statement. “Individuals who live with pain are suffering and need compassionate, individualized and effective approaches to improving pain and clinical outcomes. This report is a roadmap that is desperately needed to treat our nation’s pain crisis.”
The Task Force includes members with significant public- and private-sector experience across disciplines, including pain management, patient advocacy, substance use disorders, mental health, veteran health, and minority health. The group was created during the national opioid epidemic, but also at a time when an estimated 50 million adults in the United States experience chronic daily pain, said HHS. As such, the report emphasizes safe opioid stewardship by recommending more time for history-taking, screening tools, lab tests, and clinician time with patients to establish a therapeutic alliance and to set clear goals for improved functionality, quality of life, and activities of daily living. Medication disposal and safe medication storage are also emphasized for patient safety.
Among several issues related to opioid prescribing, the report notes a study that demonstrated treatment with opioids alone was not superior to treatment with trials of various combinations of non-opioid medications for improving pain-related function over 12 months. The research in that study showed results do not support initiation of opioid therapy alone for moderate to severe chronic back pain or hip or knee osteoarthritis pain. Buprenorphine, an opioid medication that the FDA has approved for clinical use, is a partial agonist at the mu opioid receptor and therefore has a reduced potential for respiratory depression and could be safer than full agonists such as morphine, hydrocodone, and oxycodone. The report says it also acts as an antagonist at the kappa receptor, an effect shown in experimental studies to reduce anxiety, depression, and the unpleasantness of opioid withdrawal. However, the authors did note that in some states prescribing clinicians find it difficult to get authorization for using buprenorphine for chronic pain management – an issue the final report also discusses.
Additionally, the report includes a section highlighting disparities and unique challenges faced by special populations, including veterans, active military, women, youth, older adults, American Indians and Alaska Natives, cancer patients and those in palliative care, and patients with sickle cell disease and other chronic, relapsing painful conditions.
