Improved Access to Alternative Care Is Best Option to Curb Opioid Misuse
American Pain Society Urges Expanded Insurance Coverage for Interdisciplinary Pain Care
CHICAGO, June 4, 2018 – As Congress evaluates dozens of bills designed to control misuse of opioid analgesics, the American Pain Society (APS) said today that various proposals and actions to limit opioid prescribing and supply will have the opposite impact – many legitimate pain patients cut off from their medications and desperate for relief may turn to illicit drugs, often with tragic results.
"There is a dual epidemic of chronic pain and opioid misuse, and policy debates about opioids should concentrate on wider use of proven alternative therapies, improving insurance coverage for them, and allocating significantly more federal research dollars for grants to develop new, non-addictive pain medications, said APS President William Maixner, DDS, PhD. "The supply-side approach won't work because patients denied opioids still need alternative pain treatments, which for most are unavailable or unaffordable without adequate insurance coverage."
As more and more primary care physicians stop prescribing opioids, they refer chronic pain patients to specialty clinics. Frustration ensues as patients seek alternative treatments, yet there are so few specialty clinics, especially in rural areas, and many do not accept new patients.
"Let's call it a tragic Catch-22. Doctors refer patients to specialty pain clinics, usually filled to capacity, so desperation sets in and the next stop could be a dealer on the street eager to sell heroin or synthetic fentanyl," said Maixner. "We need more specialty pain clinics but paltry reimbursements discourage qualified providers from opening them."
Maixner explained it will take years for new pain therapies to emerge from research laboratories but there are proven, non-pharmacologic alternatives to opioids with great potential to reduce opioid prescribing.
"Biopsychosocial approaches to pain assessment offer excellent potential to enhance treatment outcomes by better matching patients to appropriate treatments. Studies referenced in the National Pain Strategy show that psychosocial pain treatments work and are making a difference," Maixner said. "Medicare, Medicaid and private insurers, therefore, must offer coverage for biopsychosocial pain management as part of a comprehensive national effort to bring relief to people with chronic pain without resorting to addictive opioids."
At the recent American Pain Society Scientific Summit, speakers stressed that greater understanding of complex, underlying pain mechanisms, which are different in most patients, holds promise to improve the quality and precision of clinical pain assessments and help foster successful treatment outcomes. This is the underlying rationale for an interdisciplinary approach to pain management. In his plenary session talk, former APS President Roger Fillingim, PhD, said the complexity of the biopsychosocial mosaic that influences pain demands an equally sophisticated approach to pain assessment and treatment. "Pain treatment should target the multiple biopsychosocial drivers of a patient's pain, and the goal is to deploy personalized pain management comprised of multiple treatment modalities designed for each patient," Fillingim stressed.
"We know and have proved in numerous studies that the biopsychosocial treatments are effective for pain management," said Maixner. "Convincing payors to cover them is our biggest challenge today. But it's clear the opioid epidemic will not subside unless reimbursements for interdisciplinary pain management increase and foster expansion of these services so more patients can replace opioids with alternative, non-pharmacological treatments that offer better outcomes," said Maixner.
About the American Pain Society
Based in Chicago, the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS is the professional home for investigators involved in all aspects of pain research including basic, translational, clinical and health services research to obtain the support and inspiration they need to flourish professionally. APS strongly advocates expansion of high quality pain research to help advance science to achieve effective and responsible pain relief. For more information on APS, visit www.americanpainsociety.org.