Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations

Draft Report Overview

The Comprehensive Addiction and Recovery Act (CARA) of 2016 led to the creation of the Pain Management Best Practices Inter-Agency Task Force (Task Force), whose mission is to determine whether gaps in or inconsistencies between best practices for acute and chronic pain management exist and to propose updates and recommendations to those best practices. The Task Force consists of 29 experts who have significant experience across the disciplines of pain management, patient advocacy, substance use disorders, mental health, and minority health. This draft report describes preliminary recommendations of the Task Force that will be finalized and submitted to Congress in 2019, following a 90-day public comment period. Initial key concepts:

Balanced pain management should be based on a biopsychosocial model of care.
Individualized, patient-centered care is vital to addressing the public health pain crisis.
Ensure better and safer opioid stewardship through risk assessment based on patients’ medical, social, and family history to ensure safe and appropriate prescribing.
Multidisciplinary approach to chronic pain that focuses on the patient’s medical condition, co-morbidities, and various aspects of care including:
- Medications. Different classes depending on patient medical conditions and history.
- Restorative movement therapies. Physical and occupational therapy, massage therapy, aqua therapy.
- Interventional procedures. Different types of minimally invasive procedures can be important for both acute and chronic pain.
- Complementary and integrative health. Acupuncture, yoga, tai chi, meditation.
- Behavioral health/psychological interventions. Coping skills, cognitive behavioral therapy.
Multi-modal approach to acute pain in the surgical, injury, burn and trauma setting.
Perioperative surgical home and acute pain guidelines to provide a framework for improved patient experience and outcomes.
Addressing drug shortages that might affect acute and chronic pain care.
Access to care is vital through improved health care coverage for various treatment modalities and an enlarged workforce of pain specialists and behavioral health clinicians to help guide and support appropriately trained primary care clinicians.
Stigma is a major barrier to treatment, so it is important to provide empathy and a non-judgmental approach to improve treatment and outcomes.
Education through societal awareness, provider education and training, and patient education are needed to understand choices and promote therapeutic alliances between patients and providers.
Innovative solutions to pain management such as telemedicine, tele-mentoring, mobile apps for behavioral and psychological skills, newer medicines, and medical devices should be utilized as part of the overall approach to pain management.
Research is required to develop a better understanding of the mechanisms of pain, preventive measures, the use of innovative medical devices and medications to prevent the acute-to-chronic pain transition, and methods to improve outcomes of chronic pain conditions.
Special populations are highlighted, including pediatric, women, older adults, American Indians/Alaskan Natives, active duty soldiers/veterans, sickle cell disease (as an example of a chronic relapsing condition).