By Rebecca McKinsey

In the Comprehensive Addiction and Recovery Act, the first major federal legislation to address the opioid crisis, Congress included one provision on pain management. It directed the U.S. Department of Health and Human Services (HHS) secretary to appoint a panel of the nation’s foremost experts in pain management to report on the best ways to manage pain now, to pinpoint gaps in pain care—and to offer recommendations to fill them.

The panel’s recommendations were outlined in the HHS Pain Management Best Practices Inter-Agency Task Force Report, released in 2019.

The report’s main thrust: the best way to manage pain is through a physician-led care team and patient working together to develop an individualized, multimodal, multidisciplinary treatment plan. The task force described five broad areas of treatment: medication, restorative therapies, interventional procedures, behavioral health approaches, and complementary and integrative health.

“That concept had not really been stated that way before,” says Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation and a member of the task force. “You need to combine multiple options to effectively manage chronic pain. At present, there is no single magic bullet, no cure for chronic pain.”

Combining multiple treatment options can increase the effectiveness of pain management.

“If each modality reduces your pain another 10 or 15%, that adds up,” Steinberg notes. “It can make the difference between your ability to work or not, your ability to enjoy life or not.”

As part of the research process while drafting the report, the task force solicited input from individuals living with pain.

“Physicians haven’t been trained in this approach,” states Steinberg, who lives with chronic pain and was the only patient and patient advocate serving on the task force. “It took an expert panel to come out and say, ‘Look, medical world, this is the best way to manage pain now.’”

What the report says about acute pain

Multimodal approaches to the treatment of both acute and chronic pain should be based on a biopsychosocial model of care, taking into account biological, psychological, and social factors.

Access to care is vital when treating acute pain, according to the report, and a lack of quality medical care can contribute to the transition between acute and chronic pain.

“Medical complications from inadequately treated acute pain may include prolonged recovery time, unanticipated hospital readmissions, and transition to chronic and persistent pain,” the report states.

One group that is particularly vulnerable to acute-to-chronic pain is active duty military populations and veterans, who often experience combat-related injuries and are more likely than civilians to have complications from traumatic brain injuries.

“Delayed pain treatment following injury can increase the likelihood of acute pain becoming chronic pain in service members and veterans,” the report states. “As a nation, we must do better in fulfilling our solemn obligation to care for all those who have served our country and to improve the quality of life of our nation’s veterans.”

Applying the task force recommendations in the real world

As one of the physician representatives on the task force, Jianguo Cheng, MD, PhD, director of the Cleveland Clinic Multidisciplinary Pain Medicine Fellowship Program and past president of the American Academy of Pain Medicine, is passionate about the implementation of the report’s recommendations.

“Each patient is different; their pain condition is different,” Cheng says. “There are so many variations between individuals. How can each patient be treated the best way they deserve?”

Some patients may find effective treatment with over-the-counter medications only; others need lifestyle modifications, prescription pain medication, implanted devices, surgery—or often, a combination of treatments.

Challenges can arise when only one treatment option is considered.

“Many people, even after five back surgeries or 15 abdominal surgeries, continue to have pain,” Cheng notes. “That’s where the multidisciplinary, multimodal approach comes into play for complex cases.”

Cheng brings this philosophy into his own work as a pain physician. His approach regularly includes multiple modes of treatment.

Moving forward, there is a need for more physicians trained in multimodal pain management.

“This is not going to be accomplished in one year,” Cheng says. “It’ll take longer for the nation to recognize the need to increase the workforce in pain management.”

Additional dissemination is needed

In an initiative that drew on the PMTF report, the Centers for Medicare and Medicaid Services (CMS) recently explored barriers in access to care faced by people living with chronic pain.

“What CMS is doing now is a great thing,” Steinberg says. “Starting in January 2023, CMS is creating a separate comprehensive code for pain management which doesn’t exist now—coordinating multimodal care across disciplines, asking for comprehensive assessments, asking physicians to develop and manage treatment plans. They’re using the recommendations of the task force to come up with this code.”

For the past several years, Steinberg has ensured that a paragraph about disseminating the report is included in the U.S. Senate Appropriations budget that directs how agencies’ funds are spent. She continues to work with agencies and policy groups to increase awareness of the report’s recommendations. The report has been a focus of U.S. Pain Foundation’s advocacy efforts as well.

“I will not drop this,” Steinberg says. “So much work went into this, and it was so well-received. The report was endorsed by 160 organizations. I really do agree with our recommendations and the stake in the ground that says, ‘This is the best way to manage pain now.’ I’ve been really working hard with colleagues to make sure Congress doesn’t forget about this report.”

To view the Pain Management Best Practices Inter-Agency Task Force Report, visit: bit.ly/pmtfreport