Comprehensive, interdisciplinary, team-based, multimodal, integrative pain management (CIPM) is widely accepted as the standard of care for people living with pain. However, this is simply not happening widely. CIPM must be understood by the public and health care professionals, covered by public and private insurers, and accessible to people with pain. Promoting CIPM is vital to solving our nation’s overlapping public health crises of chronic pain, opioid misuse and overdose, and mental health disorders.
In the past decade, the sheer numbers of pain management-related policies that were proposed and/or enacted increased by hundreds compared to the prior years. This influx of pain management guidelines and regulations – state and federal, public and private – in response to our nation’s opioid misuse and overdose epidemic, has impacted the health care that is available to those in need of acute and chronic pain management. These policies have good intentions but have caused confusion with conflicting stakeholder recommendations. One example of this can be seen by reading the Center for Disease Control’s April 2019 commentary published in the New England Journal of Medicine about its own 2016 Guideline for Prescribing Opioids for Chronic Pain, stating some resulting policies and practices are inconsistent with its recommendation.
While these efforts have resulted in lower opioid prescribing rates, they do not address the underlying problem of untreated pain. In the absence of meaningful access to a coordinated and comprehensive approach to non-opioid therapies as part of the full toolbox of pain treatment options, there has been rising concern that these efforts are failing to address barriers to comprehensive, interdisciplinary, multimodal, integrative pain management and resulting in unintended adverse consequences (e.g., overdose or suicide) for people living with pain. There clearly is a widespread consensus that we need to provide a comprehensive, person-centered approach to care that includes the options right for each person’s situation, if we are to succeed in treating pain in ways that do not exacerbate the opioid crisis.
This rising concern has been percolating for many years and led to creation of a multi-stakeholder collaborative effort, now called the Alliance to Advance Comprehensive Integrative Pain Management (previously called the Integrative Pain Care Policy Congress), to take action around shared priorities in advancing quality pain management. In October 2017, 75 leaders from more than 50 organizations representing public and private insurers, people with pain, healthcare providers, purchasers of healthcare, government agencies, federal medicine, policy experts and patient/caregiver advocates convened to attend the Integrative Pain Care Policy Congress. United because of a shared desire to advance a comprehensive, interdisciplinary, integrated and integrative approach to pain care, the primary goal of the first meeting was to develop a consensus definition for the approach to pain care being discussed. Through pre-meeting surveys and live discussion, a definition for comprehensive integrative pain management was achieved.
The definition from 2017 was as follows: Comprehensive integrative pain management includes biomedical, psychosocial, complementary health, and spiritual care. It is person-centered and focuses on maximizing function and wellness. Care plans are developed through a shared decision-making model that reflects the available evidence regarding optimal clinical practice and the person’s goals and values.
Key priorities related to pain care access, public awareness, research, clinical outcomes, and education were identified during the meeting, and afterwards, stakeholders voted to create virtual workgroups to address some of these priorities. Developing white papers was a goal for two of the past workgroups titled, Improving Access to Quality Pain Care and Promoting Comprehensive Integrative Pain Management. With momentum growing, a second meeting held in Boston in November 2018 brought together 95 leaders from 75 organizations focused on identifying shared priorities for action.
The Alliance to Advance Comprehensive Integrative Pain Management (AACIPM), an initiative funded by a grant from the Lovell Foundation plus matching contributions, launched in 2019, and includes an Advisory Committee of leaders representing key stakeholders involved. AACIPM is leading efforts to complete white papers, facilitate education with and for payors and purchasers of healthcare, construct strategic policy recommendations, and create a list of CIPM practice examples across settings and patient populations. AACIPM will also host a Pain Policy Congress in May 2020.