Federal policymakers remain intensely focused on how to reduce opioid misuse, addiction, and overdose. In addition to the numerous federal initiatives that AIPM reported on earlier this year, federal policymakers from the Senate Finance Committee sent out a letter last Friday seeking comments, specifically asking how Medicare and Medicaid program incentives can be used for beneficiaries with chronic pain in ways that minimize the risk of becoming addicted to opioids.
How can Medicare and Medicaid payment incentives be used to promote evidence-based care for beneficiaries with chronic pain that minimizes the risk of developing OUD or other SUDs?
What barriers to non-pharmaceutical therapies for chronic pain currently exist in Medicare and Medicaid? How can those barriers be addressed to increase utilization of those non-pharmaceutical therapies when clinically appropriate?
How can Medicare and Medicaid payment incentives be used to remove barriers to create incentives to ensure beneficiaries receive evidence-based prevention, screening assessment, and treatment for OUD and other SUDs to improve patient outcomes?
Are there changes to Medicare and Medicaid prescription drug program rules that can minimize the risk of developing OUD and SUDs while promoting efficient access to appropriate prescriptions?
How can Medicare or Medicaid better prevent, identify, and educate health professionals who have high prescribing patterns of opioids?
What can be done to improve data sharing and coordination between Medicare, Medicaid, and state initiatives, such as Prescription Drug Monitoring Programs?
What best practices employed by states through innovative Medicaid policies or the private sector can be enhanced through federal efforts or incorporated into Medicare?
What human services efforts (including specific programs or funding design models) appear to be effective in preventing or mitigating adverse impacts from OUD or SUD on children and families?
Pain is the #1 reason patients see doctors (it either hurts or it shows) and it is the role of physicians to relieve pain and suffering. Doctors have no training in chronic pain management. We need education in chronic pain management for primary care and ER doctors with suggestions: use the lowest doses needed and don't escalate doses rapidly, don't combine with alcohol or benzodiazepines, don't overtake, monitor PMP and urine drug tests, keep meds locked up. When used in combination with alternative treatments for chronic pain opioids are safe and effective and may have less risks if used properly. The goal is to lower pain to a tolerable level to improve function without causing problems with tolerance, dependence, addiction, or overdose.
Chronic pain is a brain disease as is opioid dependence and addiction. Replacement therapy for opioid addiction saves lives so it may be reasonable to use Methadone and Buprenorphine for chronic pain in persons with opioid tolerance or addiction.
Two clear and concise recommendations. 1. Heart rate variability biofeedback is the most versatile, durable, immediate and objective manner to teach emotional self regulation, mitigate pain amplification from catastrophizing and defuel cravings. HRVB also solves major weaknesses of meditation; the inability to assign objective homework, assess compliance and assess ability to shift emotion objectively. Learning the skill to ground oneself is necessary to improve CBT efficacy and CBT financial viability. 2. Chronic pain is both physical and emotional (HRVB). Combination treatment is necessary. Clearly, the best molecule to address the physical component of pain is buprenorphine (yes, an opioid, unlikely to cause cravings) for several reasons. Buprinorphine needs to be given in a non-oral reward formulation. This leaves weekly schedule III transdermal or a newly approved subcutaneous depo (weekly or monthly) formulations.
As a clinical psychologist with post graduate certification in Neurofeedback and Neuropsychology, I have helped a number of patients reduce pain levels with accompanying anxiety and depression using biofeedback. Please review the randomized control studies, etc. published in journals. Access to these abstracts and articles may be derived from NIH.gov, AAPB.org and heartmath.org. I also had published recently an article on the Psychologist's Role in Palliative Care emphasizing hypnosis for chronic pain.
It is really simple and established through evidence based science but no one is following it! You need to follow the science! I have a short video on my website at MDHealthClinics dot com under the News tab you can see it entitled Pain and Addiction We're Causing It. You can even see a 3 min video trailer that explains the solution. I don't have a short written summary to give you but if you are truly interested you'll look at the video, or at least the trailer, and do something about the problem.