In a draft report issued December 28, 2018 by the U.S. Department of Health and Human Services (HHS)-sponsored Pain Management Best Practices Inter-Agency Task Force, recommendations for a multidisciplinary approach to pain management were formulated in an effort to treat pain in its various aspects, including its biopsychosocial effects.1 Convened in accordance with requirements set out in the Comprehensive Addiction and Recovery Act of 2016, the Task Force’s 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.”
“Chronic pain affects an estimated 50 million U.S. adults, or 20%of the adult population. An estimated 19.6 million U.S. adults have experienced high-impact chronic pain, which the [Centers for Disease Control and Prevention; CDC]defines as pain occurring and interfering with life or work activities most days….This draft report offers a wide range of treatment modalities with a framework to allow for multidisciplinary, individualized patient-centered care,” noted Vanila M. Singh, MD, MACM,Task Force chair, and chief medical officer of the HHS Office of the Assistant Secretary for Health, in a press release accompanying the report’s publication.
The 29-member Task Force, composed of federal officials, clinicians, patients,and experts in pain management and substance use disorders, included recommendations for:
- Clinical best practices/guidelines (CPGs)
- Approaches to acute and chronic pain management
- Pain treatments,including medications, restorative therapies, interventional procedures,behavioral health approaches, and complementary and integrative approaches
- Access to pain care, pain education, training, risk assessment and evaluation
- Addressing the stigma associated with chronic pain for both patients and providers
- The care of special populations, including older adults, women, ethnic and racial minorities,military members and veterans
- Pain manage mentin particular conditions (eg, pregnancy, chronic relapsing pain, and sickle cell disease)
Noting that some attempts to address the current opioid crisis have led to unintended consequences such as patient abandonment and forced tapering of opioids, the Task Force noted, “Quality pain management and CPGs can alter opioid prescribing both by offering alternatives to opioids and by clearly stating when they may be appropriate and how to consider risk assessment and benefit analysis with ongoing nonopioid treatment modalities.”
The report includes a discussion of the CDC Guideline for Prescribing Opioids for Chronic Pain, a document in which clinicians were advised to limit opioid doses in patients prescribed high doses to manage their chronic pain. The Task Force emphasized that the guideline was created to inform decision making for primary care providers and that legislators and organizations should not use it to mandate limits in opioid prescribing.