Agency for Healthcare Research and Quality (AHRQ) released Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. The evidence-based Practice Center Program at AHRQ found that interventions that improved function and/or pain for certain conditions (such as low back pain, neck pain, knee and hip osteoarthritis, fibromyalgia, and tension headache) included spinal manipulation, acupuncture, cognitive behavioral therapy, massage, multidisciplinary rehabilitation, and more. While long-term evidence was sparse, there was no evidence suggesting serious harms from any of the interventions studied.

National Institutes of Health (NIH) leadership outlines the interdisciplinary research plan for the HEAL Initiative. Launched in April 2018, the HEAL Initiative is a trans-NIH effort to advance national priorities in addressing the opioid crisis through science with a focus on two primary areas: (1) improving treatments for opioid misuse and addiction, and (2) enhancing strategies for pain management. In part, critical components of the HEAL research plan include:

• Supporting discovery and development of targets for non-addictive pain management, and therapies to treat those targets.
• Collecting data to determine what factors lead acute pain to transition to chronic pain and how to block that transition.
• Partnering with public and private groups to test effective treatments for pain and addiction using HEAL’s clinical trial networks.

The Pain Management Best Practices Inter-Agency Task Force held its first meeting from May 30-31 and received over 2,500 written comments. Created by Section 101 of the Comprehensive Addiction and Recovery Act of 2016 and administered by the Department of Health and Human Services, the Task Force is to identify (and propose solutions to) gaps or inconsistencies between best practices for pain management developed or adopted by Federal agencies. Following the initial meeting, three subcommittees were formed to further investigate:

1. Medication; physical therapy; surgical and minimally invasive procedures;
2. Psychological approaches; risk assessment; stigma;
3. Complementary and alternative medicine; access to care; and, education.

Center for Medicare & Medicaid Services (CMS) released their Roadmap to Address the Opioid Epidemic. Related to the area of prevention, the roadmap encourages prescribers to manage pain using a safe and effective range of treatment options that rely less on prescription opioids. While the roadmap claims that significant progress has been made in identifying overprescribing patterns, it also acknowledges that CMS must build on these efforts by promoting effective, non-opioid pain treatments by identifying and developing solutions for treatment barriers that prevent people from accessing non-opioid pain treatments across Medicare, Medicaid, and private insurance plans.

Congress continues to consider scores of bills related to pain management, opioids, and substance use disorder.

• On June 13^th, HR 6 was introduced, also known as the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. After much debate over a whole slew of bills, the newly introduced SUPPORT for Patients and Communities Act will serve as the underlying vehicle for the majority of House-passed bills to combat the opioid crisis to move over to the Senate. While most of the bill pertains more directly to substance use disorder treatment, the bill does have provisions encouraging the use of non-opioid analgesics for the management of post-surgical pain (Section 202) and clarifying FDA regulation of non-addictive pain and addiction therapies (Section 301).
• On June 12^th, the House passed 25 bills aimed at fighting opioid addiction and overdoses. While many of the bills relate to naloxone access, law enforcement, and substance use disorder, one important measure would allow the National Institutes of Health to develop more treatments for pain that are not addictive.
• On June 12^th, the Senate Finance Committee voted to unanimously approve, as amended, the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act. In part, the legislation would require Medicare and Medicaid to provide beneficiaries better education, prevention, management and treatment options for pain and addiction and increase Medicare beneficiary awareness of non-opioid alternative treatments.