HHS Releases National Pain Strategy

A National Pain Strategy that outlines the federal government’s first coordinated plan for reducing the burden of chronic pain has been released.

The report, issued by the Office of the Assistant Secretary for Health at the Department of Health and Human Services (HHS), comes on the heels of new opioid prescribing guidelines released recently by the Centers for Disease Control and Prevention (CDC).

Key elements of the new pain strategy include education and care by providers, as well as prevention, says Linda Porter, PhD, director, National Institute of Health’s (NIH’s) Office of Pain Policy, and co-chair of the Interagency Pain Research Coordinating Committee (IPRCC) working group that helped develop the report.

Among other things, the education aspect addresses the “low level” of education about pain that students receive in medical school, said Dr Porter. Prevention strategies will include approaches such as workplace changes to prevent repetitive tasks that can lead to injuries, she said.

The strategy advocates providing a “biopsychosocial” approach to people with chronic pain, she said. It recommends better tools to enable “coordinated care at all professional levels,” she said.

Key Steps

Chronic pain is a significant public health problem, affecting millions of Americans and incurring substantial economic costs to society, said Karen B. DeSalvo, MD, HHS acting assistant secretary for health, in a press release. “This report identifies the key steps we can take to improve how we prevent, assess and treat pain in this country.”

In response to a 2011 Institute of Medicine report calling for a coordinated effort to transform approaches to pain management and prevention, the HHS tasked the IPRCC, which included government representatives, scientists, and patient advocates, with developing a National Pain Strategy.

In addition to professional education and prevention, the strategy makes recommendations for improving overall pain care in four other key areas: population research, disparities, service delivery and payment, and public education and communication.

“Of the millions of people who suffer from chronic pain, too many find that it affects many or all aspects of their lives,” said Dr Porter. “We need to ensure that people with pain get appropriate care, and that means defining how we can best manage pain care in this country.”

In developing the report, the IPRCC engaged with a broad range of experts, including pain care providers, scientists, insurers, patient advocates, accreditation boards, professional societies, and government officials.

The Office of the Assistant Secretary for Health, in conjunction with other HHS divisions, will now consider the recommendations included in the strategy and develop an implementation and evaluation plan based on this process. In addition, the IPRCC is creating a research agenda to advance pain-related research in an effort to realize the goals of the strategy.

Some of these initiatives are already under way, she noted.

o help achieve the goals in the report, “we will need everyone working together to create the cultural transformation in pain prevention, care and education that is desperately needed by the American public,” said Sean Mackey, MD, PhD, chief, Division of Pain Medicine, Stanford University, and a co-chair of the IPRCC working group, in the press release.

Opioid Epidemic

The strategy provides opportunities for reducing the need for and over-reliance on prescription opioid medications. Its goals can be achieved through a broad effort in which better pain care is provided, along with safer prescribing practices, such as those recommended by the CDC, as part of the government’s urgent response to the epidemic of overdose deaths.

The new pain strategy and the opioid prescribing guidelines are parallel and complementary initiatives, stressed Dr Porter.

“There is a clear opioid problem” in this country, she said.

Helping to create and fuel the epidemic of opioid-associated overdoses and deaths is increased prescribing and sales of opioids — a quadrupling since 1999, according to the CDC.

The new CDC guideline provides recommendations on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing). By using the guideline, primary care physicians can determine whether and when to start opioids to treat chronic pain.

The guideline also offers specific information on medication selection, dosage, duration, and when and how to reassess progress and discontinue medication if needed.