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PAIN MANAGEMENT BEST PRACTICES INTERfiAGENCY TASK FORCE REPORT

BEST PRACTICES

PAIN MANAGEMENT BEST PRACTICES

INTER-AGENCY TASK FORCE REPORT

Updates, Gaps, Inconsistencies, and Recommendations

PAIN MANAGEMENT

FINAL REPORT

Submitted by the:

Report Date:

Copyright Information:

Suggested Citation:

Report: Updates, Gaps, Inconsistencies, and Recommendations. Retrieved from U. S. Department of Health and Human

Services website: https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html Executive Summary ........................................................................ Task Force Members ........................................................................ De?nitions ........................................................................

1. Introduction ........................................................................

2. Clinical Best Practices ........................................................................

.19 2.1.1 Acute and Chronic Pain ........................................................................ ................21 2.1.2

Perioperative Management of Chronic Pain Patients........................................................................

.................................23 Acetaminophen ........................................................................ ............24 NSAIDs ........................................................................ ...........................24 Anticonvulsants ........................................................................ ............24 Antidepressants ........................................................................ ...........24 Musculoskeletal Agents ........................................................................ Antianxiety Medications ........................................................................ Opioids ........................................................................ ...........................25 2.2.1

Overdose Prevention Education and Naloxone ........................................................................

.......................31 Therapeutic Exercise ........................................................................ ...31

Transcutaneous Electric Nerve Stimulation ........................................................................

....................................32 Massage Therapy........................................................................ .........32 Traction ........................................................................ ..........................32 Cold and Heat ........................................................................ ...............32 Therapeutic Ultrasound ........................................................................ Bracing ........................................................................ ...........................32 ................33 Epidural Steroid Injections ........................................................................

Facet Joint Nerve Block and Denervation Injection ........................................................................

......................34 Cryoneuroablation ........................................................................ .......34 Radiofrequency Ablation ........................................................................ Peripheral Nerve Injections ........................................................................ Sympathetic Nerve Blocks ........................................................................ Neuromodulation ........................................................................ .........35

Intrathecal Medication Pumps ........................................................................

Vertebral Augmentation ........................................................................ Trigger Points ........................................................................ ................35 Joint Injections ........................................................................ .............36

Interspinous Process Spacer Devices ........................................................................

Regenerative/Adult Autologous Stem Cell Therapy ........................................................................

.....................36 2.5

Behavioral Health Approaches ........................................................................

.......37 Behavioral Therapy ........................................................................ .....38

Cognitive Behavioral Therapy ........................................................................

Acceptance and Commitment Therapy ........................................................................

Mindfulness-Based Stress Reduction ........................................................................

Emotional Awareness and Expression Therapy ........................................................................

.............................38

Self-regulatory or Psychophysiological Approaches ........................................................................

....................38 2.5.1

Access to Psychological Interventions ........................................................................

2.5.2

Patients with Chronic Pain as well as Mental Health and Substance Use Comorbidities .....................................40

Acupuncture ........................................................................ .................43

Massage and Manipulative Therapies ........................................................................

MBSR ........................................................................ ..............................43 Yoga ........................................................................ ................................43 Tai chi ........................................................................ .............................43 ......................44 ............................44 2.7.1

Unique Issues Related to Pediatric Pain Management ........................................................................

..............................44 2.7.2 Older Adults ........................................................................ ......................................45 2.7.3

Patients with Cancer-Related Pain and Patients in Palliative Care ........................................................................

........46 2.7.4

Unique Issues Related to Pain Management in Women ........................................................................

...........................46 2.7.5 2.7.6

Chronic Relapsing Pain Conditions ........................................................................

2.7.7 Sickle Cell Disease ........................................................................ .........................48 2.7.8 Health Disparities in Racial and Ethnic Populations, Including African-Americans, Hispanics/Latinos,

American Indians, and Alaska Natives ........................................................................

2.7.9

Military Active Duty, Reserve Service Members, and Veterans ........................................................................

...............50

3. Cross-Cutting Clinical and Policy Best Practices ........................................................................

.................................53 3.1.1

Prescription Drug Monitoring Programs ........................................................................

3.1.2 Screening and Monitoring ........................................................................ ............55 3.3 Education ........................................................................ 3.3.1 Public Education ........................................................................ ..............................59 3.3.2 Patient Education ........................................................................ ............................60 3.3.3 Provider Education ........................................................................ .........................61 3.3.4

Policymaker, Regulator, and Legislator Education ........................................................................

...........................62 3.4.1 Medication Shortage ........................................................................ .....................63 3.4.2

Insurance Coverage for Complex Management Situations ........................................................................

.....................64 3.4.3 3.4.4 Research ........................................................................

4. Review of the CDC Guideline ........................................................................

Federal Resources Center ........................................................................ Acronyms ........................................................................ References ........................................................................

LIST OF FIGURES

Figure 1: .............................12

Figure 2:

Task Force Expertise ........................................................................ .......................14 Figure 3: ...........................................................15

Figure 4: ....19

Figure 5: ........................................................................

Figure 6:

Includes All Necessary Treatment Options ........................................................................

Figure 7: ........................................................................ ....23 Figure 8: ........................................................................ ................24 Figure 9: ........................................................................ ..30 Figure 10:.....................................................31 Figure 11: .............................................33 Figure 12: .....................................................................34 Figure 13: ................................................................37 Figure 14: ........................................................................

Figure 15: ..........................41

Figure 16:

Consist of a Variety of Interventions ........................................................................

Figure 17:

Unnecessary Opioid Exposure ........................................................................ Figure 18: ........................................................................ ....57

Figure 19:

With Prescription Opioids ........................................................................ ..............59 PAIN MANAGEMENT BEST PRACTICES INTERfiAGENCY TASK FORCE REPORT

Patients with acute and chronic pain in the United States face a crisis because of significant challenges in obtaining

adequate care, resulting in profound physical, emotional, and societal costs. Accordi ng to the Centers for Disease Control

and Prevention, 50 million adults in the United States have chronic daily pain, with 19.6 million adults experiencing high-

impact chronic pain that interferes with daily life or work activities. The cost of pain to our nation is estimated at between

$560 billion and $635 billion annually. At the same time, our nation is facing an opioid crisis that, over the past two

decades, has resulted in an unprecedented wave of overdose deaths associ ated with prescription opioids, heroin, and synthetic opioids.

The Pain Management Best Practices Inter-Agency Task Force (Task Force) was convened by the U.S. Department of

Health and Human Services in conjunction with the U.S. Department of Defense and the U.S. Department of Veterans

A?airs with the O?ce of National Drug Control Policy to address acute and chronic pain in light of the ongoing opioid

crisis. The Task Force mandate is to identify gaps, inconsistencies, and updates and to make recommendations for best

practices for managing acute and chronic pain. The 29-member Task Force included federal agency representatives as

well as nonfederal experts and representatives from a broad group of stakeholders. The Task Force considered relevant

medical and scientific literature and information provided by governme nt and nongovernment experts in pain management, addiction, and mental health as well as representatives from various dis ciplines. The Task Force also reviewed and considered patient testimonials and public meeting comments, including a pproximately 6,000 comments from the public submitted during a 90-day public comment period and 3,000 comments from two public meetings.

The Task Force emphasizes the importance of individualized patient-centered care in the diagnosis and treatment

of acute and chronic pain. This report is broad and deep and will have s ections that are relevant to di?erent groups of stakeholders regarding best practices. See the table of contents and the sec tions and subsections of this broad report to best identify that which is most useful for the various clinical discipl ines, educators, researchers, administrators, legislators, and other key stakeholders. The report emphasizes the development of an e?ective pain treatment p lan after proper evaluation to establish a diagnosis with measurable outcomes that focus on improvements, including quality of lif e (QOL), improved functionality, andquotesdbs_dbs30.pdfusesText_36

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