HHS Inter-Agency Pain Task Force Draft Report

[drusso]

Draft Report on Pain Management Best Practices

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[Ducttape]

Most catching is the fact that the report mentions cryo- ablation and Pulses RF and suggests that they may benefit; establish some criteria for credentialling docs to do interventional procedures, and recommend expanding alternative treatment...

Med section doesn’t say much startling, other than never prescribe soma.

All stuff you learn in anACGME program, btw...

 

[Disciple]

Anyone think these become the de facto treatment guidelines?

 

[drusso]

Anyone think these become the de facto treatment guidelines?

There's awareness at all levels that the Core Expert Group that brokered the CDC Guidelines had ideological conflicts of interest. The recommendation that the 2016 CDC guidelines be updated with broader stakeholder input is wise.

Draft Report on Pain Management Best Practices

"An unintended consequence of the guideline is the forced tapering or patient abandonment that many patients with chronic pain on stable long-term doses of opioids have experienced. The Task Force received public comments indicating that many patients have experienced access issues related to provider fears and concerns with how the guideline would be interpreted and have caused some to consider obtaining opioids from illicit sources or suicide. PCPs should be encouraged to refer to or seek input from pain specialists and (potentially) addiction specialists in complex or high-risk patient scenarios. The CDC guideline, along with concern about undue burdens of investigation and prosecution by drug enforcement, has been cited in part by doctors and other key health care providers when deciding to limit or not to provide pain treatment.13 Experts have also noted that the CDC guideline does not sufficiently emphasize that optimal pain management begins with identification of the cause of the pain and the biopsychosocial mechanisms that contribute to its severity and associated disability."

 

[Disciple]

There's awareness at all levels that the Core Expert Group that brokered the CDC Guidelines had ideological conflicts of interest. The recommendation that the 2016 CDC guidelines be updated with broader stakeholder input is wise.

Draft Report on Pain Management Best Practices

"An unintended consequence of the guideline is the forced tapering or patient abandonment that many patients with chronic pain on stable long-term doses of opioids have experienced. The Task Force received public comments indicating that many patients have experienced access issues related to provider fears and concerns with how the guideline would be interpreted and have caused some to consider obtaining opioids from illicit sources or suicide. PCPs should be encouraged to refer to or seek input from pain specialists and (potentially) addiction specialists in complex or high-risk patient scenarios. The CDC guideline, along with concern about undue burdens of investigation and prosecution by drug enforcement, has been cited in part by doctors and other key health care providers when deciding to limit or not to provide pain treatment.13 Experts have also noted that the CDC guideline does not sufficiently emphasize that optimal pain management begins with identification of the cause of the pain and the biopsychosocial mechanisms that contribute to its severity and associated disability."

The draft looks very reasonable.

Other interesting points are encouraging insurance coverage of interventional procedures early in the treatment course, and encouraging that the procedures to be performed outside of the hospital setting.

So, if we do our usual political debate on this:

This comes from Trump's Dept. of HHS. Current head of HHS clerked for Antonin Scalia, worked at HHS under the most recent Bush administration, then was at Eli Lilly for about 10 years.

Opinions on how the best practices report might be different under other administrations?

 

[drusso]

The draft looks very reasonable.

Other interesting points are encouraging insurance coverage of interventional procedures early in the treatment course, and encouraging that the procedures to be performed outside of the hospital setting.

So, if we do our usual political debate on this:

This comes from Trump's Dept. of HHS. Current head of HHS clerked for Antonin Scalia, worked at HHS under the most recent Bush administration, then was at Eli Lilly for about 10 years.

Opinions on how the best practices report might be different under other administrations?

People who align themselves with Democratic Party causes and policies, tend to enjoy imagining doctors working for the Post Office. In other ways, they despise private enterprise.

 

[Ducttape]

Making global unsupported assumptions again, eh?

 

[hyperalgesia]

Draft Report on Pain Management Best Practices

Well this is refreshing. The authors clearly had input from pain experts.

 

[emd123]

Can someone summarize this. The document is long as hell.

 

[drusso]

Can someone summarize this. The document is long as hell.

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).

 

[hyperalgesia]

Can someone summarize this. The document is long as hell.

Common procedures done by highly trained Pain Specialists, including ESIs, MBBs, RFAs, can help people and can help alleviate the opioid epidemic...

 

[drusso]

Making global unsupported assumptions again, eh?

Read the DNC platform on health care and follow Alexandria Ocasio-Cortez on twitter and tell me what you think. This is the future of the Progressive movement.

 

[Ducttape]

And she is only 1 one congresswoman. Making blanket statements on one new congresswoman is narrow minded. Kind of like saying that all republicans think like Hyde-Smith, or assuming that the House Freedom Caucus represents all republicans

Particularly in light that she has been significantly criticized by a Democratic senator (albeit outgoing) McCaskill.


Health Care - Democrats

So, do you think that Americans should go bankrupt if they get sick?

 

[Ducttape]

Common procedures done by highly trained Pain Specialists, including ESIs, MBBs, RFAs, can help people and can help alleviate the opioid epidemic...

That is a Total misinterpretation...

But you were being facetious, right?

 

[hyperalgesia]

That is a Total misinterpretation...

But you were being facetious, right?

Um no. Did you read the pain section?

Just a sample:
ESIs are one the most common procedures in pain management and, in well-selected patients, can provide significant pain relief as part of a pain management plan.181 Although risks are associated with ESIs, they offer significant advantages to the patient, notably in that they may potentially reduce health care costs, health care utilization, and the need for future surgical intervention.182

 

[emd123]

Read the DNC platform on health care and follow Alexandria Ocasio-Cortez on twitter and tell me what you think. This is the future of the Progressive movement.

I've read enough of AOC's statements to know she's an intellectual lightweight who makes up for her lack of wisdom and common sense with extremely strong skills of persuasion among her radical socialist base and millennials. That makes her dangerous enough that she should not to be underestimated.

 

[Ducttape]

and you choose to focus on one small tiny portion of the draft. look at what drusso already posted above. interventional pain procedures dont make up even 1/10 of the total amount of the draft report. for example, the pain interventions section has 1565 words in it. meds 5095, of which opioids are 4262. complementary therapy ie chiro et al 1293.

(total document 24,614 words, so technically interventional pain procedures make up 6% of the document)

what is written discusses balanced, individualized, safer opioid, multidisciplinary treatment (of which injections are a part of this)... and you choose to only discuss injections.




"can help alleviate the opioid epidemic"
actually, the document makes no such comment.

 

[allantois]

People who align themselves with Democratic Party causes and policies, tend to enjoy imagining doctors working for the Post Office. In other ways, they despise private enterprise.

Eh Republicans are the champions of the war on drugs, prescription or otherwise

 

[Doctodd]

Occasional-Cortex is great to watch...i love watching her try to persuade me that socialism is great. Unfortunately she convinces many young, ignorant, and naive people.