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Pain Continues to Dominate the National Conversation: News from Congress, FDA, and HHS

Posted By Katie Duensing, Thursday, October 11, 2018

Congress has overwhelmingly passed the SUPPORT Act (HR 6), and the President is expected to sign the bill into law in a signing ceremony on October 24th. The massive 660-page bill is the second piece of sweeping legislation to pass in two years related to the opioid overdose and misuse epidemics, the first being the Comprehensive Addiction and Recovery Act of 2016 (CARA). While the legislation’s primary focus is on substance use disorder treatment and prevention, there is also some focus on comprehensive integrative pain management. In part:

  • Section 1010 directs the Centers for Medicare & Medicaid Services to issue guidance documents to States regarding mandatory and optional items and services that may be provided under a State plan for non-opioid treatment and management of pain, including, but not limited to, evidence-based, non-opioid pharmacological therapies and non-pharmacological therapies.
  • Section 6086 requires the Secretary of Health and Human Services to submit a report to Congress containing options for revising payment to providers and suppliers of services and coverage related to the use of multi-disciplinary, evidence-based, non-opioid treatments for acute and chronic pain management for individuals entitled to benefits under part A or enrolled under part B of title XVIII of the Social Security Act.

The Food and Drug Administration recently released an updated version of their Opioid Analgesic Risk Evaluation and Mitigation Strategy (Opioid REMS). Unlike previous iterations of the Opioid REMS, the new strategy stresses the need to utilize comprehensive integrative pain management as a part of a well-rounded treatment plan. In part, the strategy states that health care providers (HCPs) treating patients with pain should:  

  • Be knowledgeable about the range of therapeutic options for managing pain, including nonpharmacologic approaches and pharmacologic (non-opioid and opioid analgesics) therapies, upon completion of educational activities related to the Opioid REMS.
  • Attempt to overcome potential barriers when managing patients with pharmacologic and/or nonpharmacologic treatment options, such as lack of insurance coverage or inadequate availability of certain HCPs.
  • Be knowledgeable about the range of treatment options available, the types of pain that may be responsive to those options, and when they should be used as part of a multidisciplinary approach to pain management.

The second meeting of the Pain Management Best Practices Inter-Agency Task Force (Task Force) was held September 25th-26th in Washington, D.C.  The Task Force considered public comment, deliberated, and voted on the draft Task Force recommendations for acute and chronic pain management. The draft recommendations are expected to be released to the public near the end of October or the beginning of November, at which time a 90-day public comment period will commence.

The National Institutes of Health has released several Funding Opportunity Announcements specific to pain research as part of the HEAL (Helping to End Addiction Long-term) Initiative. Funding is available for research related to:

  • Analytical and/or Clinical Validation of a Candidate Biomarker for Pain
  • Discovery and Validation of Novel Targets for Safe and Effective Pain Treatment
  • Chronic Overlapping Pain Conditions

A complete list of funding opportunities and due dates can be found here.

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Update, 10/26/2018:

The SUPPORT Act was signed into law on October 24, 2018.

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Comments on this post...

Debbie N. Heck MD-Retired says...
Posted Tuesday, October 16, 2018
I feel opioids are being far too abandoned in all this. YES, nonopioids have their place, BUT NSAIDs cause heart and kidney damage. Overuse of Tylenol causes liver damage. Physical therapy only goes so far as do OTHER treatment modalities such as massage, swimming, TENS units etc. Opioids STILL have their place and are NOT being STRESSED as a VITAL PART OF PAIN MANAGEMENT! The phrase "throwing the baby out with the bathwater" seems highly appropriate here. Yes, INTEGRATIVE THERAPY should be just that: something INTEGRATED along with the GOLD STANDARD of RESPONSIBLE use of opioids. I continue to feel opioids are being ABANDONED in this discussion along with pain patients whose views aren't truly being heard. Yes adjunctive therapies ARE important. I was a MAVERICK in 1999 by having a massage therapist in my FP solo office along with a dietitian so NOBODY can say I was some "pill pusher." We had one of those in town. I also turned in scammers to the drug task force and kept as clean a practice as possible. I want to see more BALANCE back in this.
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Dean R. Melrose LCMHC says...
Posted Tuesday, October 16, 2018
I agree 100% with Dr Heck. I see chronic pain patients and treat them with CBT. I have found that a large number of my patients are not given any opiates for there chronic pain. Therapy can only go so far and pain patients don't deserve to be treated as med seekers. All they want is appropriate treatment of there pain so they can move on with there lives.In addition Im a chronic pain patient myself and have found helping this population a very rewarding experience
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