Connecting the Dots: IOM (now NAM), CARA 3.0 and Whole Person, Multidisciplinary Pain Management
by Amy Goldstein, MSW, Director, AACIPM
Governmental policy has a significant impact on the way healthcare is provided, and CARA is one of the key policies impacting people living with pain. In recent years, many hundreds of policies have been enacted to address opioid misuse and pain management, the majority of which have happened on the state level. Among the federal laws, the Comprehensive Addiction and Recovery Act (CARA) was first enacted in July 2016. CARA was considered landmark legislation and had unprecedented bipartisan support. The final version included 50 sections of detailed provisions in a deliberate attempt to be a coordinated and comprehensive response to the nation’s opioid overdose and misuse epidemic.
Two components of CARA that have been important to this Alliance include:
- Establishment of the HHS Interagency Pain Management Best Practices Task Force.
- Issuance of the directive for the Veteran Administrations Whole Health Initiative pilot, specifically calling out pain management.
CARA 3.0 was introduced last month, so it’s timely and relevant to synthesize a number of things related to the various versions of CARA, and how it relates to AACIPM’s work, in an effort to clarify institutional knowledge and underscore action steps that are tied to a bigger effort where alignment with many different stakeholders is focused on individualized, multidisciplinary pain care and self-management.
Read on for answers to questions, such as:
What is CARA, CARA 2.0, & key measures in pending CARA 3.0?
How Does it Relate to AACIPM’s Work, the HHS Interagency Pain Management Task Force and VA’s Whole Health Initiative?
How did the Institute of Medicine act as a catalyst?
Advanced by Passage of CARA, Veterans Connected to Whole Health Increased by 193%
Thanks to a directive in CARA (2016), the Veterans Administration radically changed its approach to health care and is piloting the Whole Health Initiative in 18 sites.
In April 2021, the Veterans Administration released initial findings from this pilot showing an increase in Whole Health services to Veterans by 193%.
The Whole Health approach to care features conventional clinical care (such as pharmacy, medical care, or counseling) and complementary and integrative care (such as acupuncture or yoga) working together as part of an overall treatment plan.
Veterans who used Whole Health services to manage their chronic pain used opioid medications three times less compared to those who did not, and the pain outcome measures improved. Those who used Whole Health services reported being able to manage stress better and noted the care they received as being more patient centered. These results indicate improvements in Veterans’ overall well-being.
AACIPM Call to Action: Familiarize yourself with these results from the VA program and share with others. AACIPM included this information in a 2020 focus group with employers. Also, forthcoming in 2021, AACIPM is partnering with the Duke-Margolis Center for Health Policy and Duke Department of Orthopaedic Surgery to help disseminate work informed by findings from their Roundtable on Integrated Pain Management, including four case studies of successful integrated pain management programs and more. This information provides practical evidence to share with policy makers and legislators when educating decision makers about the value of integrative pain management systems.
A Year Later: Twillman Talks Telehealth
The AACIPM team thought it would be interesting to ask Bob Twillman, PhD, FACLP, Pain Management Psychologist, Saint Luke’s Health System, some follow up questions about how telehealth has evolved one year after his last post on the topic. Through the questions, we are connecting timely issues related to pain management, mental health, and policy implications that matter to many.
Over a year into the COVID-19 pandemic, what has your experience been transitioning to telehealth? Has it gone better or worse than you initially expected?
I would say it has gone a little better than I expected. I was apprehensive at first that I might not be able to do some of the things I usually do with patients, such as teaching them relaxation/meditation exercises, but it turns out that I can do that just as well.
What change would you like to see?
I would like to see policymakers and health systems make affordable, easy-to-use technology and broadband available for all patients to use.
Quality Integrative Pain Management Education
AACIPM is promoting this conference because it is a solid example of interprofessional and integrative pain management targeted for all providers.
Interested in the business case for comprehensive integrative pain management? Univ. of Vermont’s Comprehensive Pain Program is the result of an innovative partnership with BC/BS that is piloting a value-based bundled payment model to care for patients with chronic pain.
On May 7, the Integrative Pain Management Conference will be presented by UVM Integrative Health and hosted by the University of Vermont College of Nursing and Health Sciences.
Feel free to share this high-quality resource with your networks.
Earn Continuing Education Credit & Access Conference Recordings for two years (application pending). UVM Registration Rates are found here.
Two Types of Discounts on Registration Fees:
1. Promo code AACIPM for $50 off of the regular rate for all provider types and $25 off the student rate.
2. Scholarships Available for Healthcare Providers Caring for the Underserved
Do you, or others in your network, provide pain care to underserved populations?
If so, there is a scholarship opportunity to attend the UVM Integrative Pain Management Conference, developed in collaboration with AACIPM, University of Vermont Integrative Health, and Integrative Medicine for the Underserved around our shared goal to prepare a team-centric, culturally responsive workforce to address the demand for whole person pain management in the underserved.
On-Demand, Free Integrative Pain Management with CME
This free, self-directed course is jointly provided by Tufts University School of Medicine Office of Continuing Education and Center for Innovation in Family Medicine and can be accessed at integrativepaincme.com. The course, certification and credits are available for free through a grant from the Samueli Foundation.
“Our goal is to expand the discussion about how pain affects all aspects of a patient’s life and begin to address these as well as the pain itself. These modules will help providers deliver a more whole person, integrative approach to pain”, said Wayne Jonas, MD, presenter in the course.
Earn up to 12 AAFP Prescribed Credits and 4 AMA PRA Category 1 Credits™
Announcement – Conference on Underserved
AACIPM collaborates with organizations like IM4US to promote equity in access to comprehensive pain management for people who are underserved. We are submitting proposals to this conference and hope you’ll consider it, too!
IM4US Call for Proposals – 11th Annual Conference: Due May 1
Theme: Decolonizing Medicine: Toward Equity and Inclusivity in Integrative Healthcare
This year’s IM4US conference welcomes contributions on the following themes as well as other areas related to equity and inclusivity in integrative healthcare:
- Using anti-racist and/or re-Indigenizing strategies to address social and structural determinants of health;
- Lifting up models of financially accessible, trauma-informed, culturally-safe and culturally-responsive healthcare;
- Building trustworthy healthcare organizations;
- Transforming biomedical supremacy, environmental racism, and cultural misappropriation in healthcare;
- Expanding what ‘evidence’ means for marginalized communities and practices;
- Redefining professional expertise through dignified collaboration between diverse healthcare practitioners, patients, and communities; and
- Recognizing and honoring community-based health sovereignty.
Proposals will be housed within four conference tracks aligned with the IM4US mission: Outreach, Education, Research & Practice, and Advocacy.
Trauma and Chronic Pain
Initial Findings from RCT on Trauma-Sensitive Yoga & PTSD related to military sexual trauma
The prevalence of PTSD symptoms in our chronic pain population exceeds the prevalence of PTSD in the general population. There are concerns that people with symptoms of trauma will have higher pain severity and be younger than average. Anecdotally, many providers caring for people who are underserved describe trauma and chronic pain as intertwined topics and researchers are paying attention.
For example, results were recently shared from an interim analysis of data collected from an ongoing multisite randomized clinical trial assessing the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) for post-traumatic stress disorder (PTSD) among women veterans with PTSD related to military sexual trauma (MST). The results demonstrate that TCTSY may be an effective treatment for PTSD that yields symptom improvement more quickly, has higher retention than cognitive processing therapy, and has a sustained effect.
Related Conference – June 3 at 1pm ET
The Evolving Discussion on Military Sexual Misconduct and Military Sexual Trauma: An Introduction is the first part of a Virtual Symposium Series that will feature practitioners, researchers, leaders and individuals with lived experience working to improve knowledge, understanding, supports and treatments for Military Sexual Trauma in Canada.
Symposium on Yoga Therapy and Research – June 17-19
The International Association of Yoga Therapists‘ SYTAR symposium will feature wide-ranging education, dynamic keynotes aimed at rich professional and personal development. Key sessions of interest include: Yoga and Whole-Person Health keynote presented by Helene Langevin, NCCIH; Yoga & Yoga Therapy in Cancer Care, and Yoga Therapy Assessments.
Use Promo Code AACIPM2021 for $30 off registration.
Message from the Director
This issue is particularly focused on connecting the dots between policy and implementation, to help translate many exciting advancements into ideas, action ideas, shared resources, and more that will move the proverbial ball down the court.
In relation to the federal policy, CARA 3.0, that was introduced last month, below are some thoughts (from a longer blogpost I wrote) about what we can do together.
CARA 3.0 – What Can We Do Next
The stigmatization and marginalization of people living with chronic pain (and mental health challenges) has been evidenced for decades and I challenge us to use CARA 3.0, and other levers, to speak out boldly. We have so much foundational work to educate and motivate decision-makers to take actions that are practical, pragmatic and definitive in addressing the needs of people with pain and the health care systems that support them.
We need to collectively advocate to authorize funds for meaningful implementation of the HHS Interagency Pain Management Best Practices Report for people living with pain. This government-sanctioned report offers a credible baseline for what is possible as we all strive to move the needle for truly patient-centered, multidisciplinary, multimodal, integrative pain management approaches. This is a huge opportunity to galvanize efforts around practical and tangible implementation because this report includes all the parts of a comprehensive approach to pain management.
Onward and Upward!
ACPA and Stanford Medicine Release Resource Guide to Chronic Pain Management, an Integrated Guide to Comprehensive Pain Management Therapies
The American Chronic Pain Association and Stanford Medicine, Division of Pain Medicine, have released a 2021 edition of the Resource Guide to Chronic Pain Management: An Integrated Guide to Comprehensive Pain Therapies that includes extensive updates compared to the 2020 version. Updates and additions include information related to pelvic pain; exercise, movement, and tai chi; invasive procedures; cognitive behavioral therapy; pain in pregnancy; pediatric pain; finding psychology resources for patients on Medicaid or Medicare; and more.
NEJM Catalyst Publishes Resource to Promote Patient Empowerment and Responsibility
The Power of the Patient Voice: How Health Care Organizations Empower Patients and Improve Care Delivery examines how leading health care organizations have given patients a more prominent voice, so they can take greater responsibility and be more accountable for their own care.
How Telehealth Expands Collaborative Care in Private Practices, Healthcare Exec Intelligence, April 27
This Is What Migraine Really Does to Your Life, Self, April 26
Podcast: Training Physical Therapists to Address the Opioid Epidemic from a Public Health Perspective, Integrative Pain Science Institute, April 21
Study identifies higher mortality risk for women with back pain, News Medical Life Sciences, April 20
Conditioned Pain Modulation and Cold Conditioning Stimulus Among Patients With Chronic Upper Limb Neuropathy, Clinical Pain Advisor, April 8
Rx Summit Spotlight | Veterans Administration Takes Multi-Faceted Approach to Opioid Risk Mitigation, Psychiatry & Behavioral Health Learning Network, April 1
Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine, The Lancet Rheumatology, March 30