Difference between revisions of "Expand Programs & Options for Chronic Pain Management"
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Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Reduce_Accesss_to_Opioids|Zoom Map (Reduce Access to Opioids)]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Minimize_Desire_to_Misuse_Opioids|Zoom Map (Minimize Desire to Misuse Opioids)]] | Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Reduce_Accesss_to_Opioids|Zoom Map (Reduce Access to Opioids)]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Minimize_Desire_to_Misuse_Opioids|Zoom Map (Minimize Desire to Misuse Opioids)]] | ||
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*More than 100 million Americans suffer from chronic pain.<sup class="reference">[3]</sup> | *More than 100 million Americans suffer from chronic pain.<sup class="reference">[3]</sup> | ||
| − | <br/> | + | = <br/> Non-opioid treatment<sup class="reference">[4]</sup> = |
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| + | In addition to the pain itself, chronic pain involves sleeplessness, an inability to remain active, and anxiety, which can also affect the person's relationships. Non-opioid approaches not only reduce pain but can also address those other aspects of chronic pain like quality of life. Some other recommended options include Cognitive Behavior Therapy (CBT), Quell. | ||
*Quell is a wearable technology that uses an electrical stimulator to trigger your brain to release enkephalins, a natural pain blocking molecule. It also contains a sleep tracker to help you understand your disease and its impact on rest. | *Quell is a wearable technology that uses an electrical stimulator to trigger your brain to release enkephalins, a natural pain blocking molecule. It also contains a sleep tracker to help you understand your disease and its impact on rest. | ||
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= Promising Practices for Health Plans to Support Alternate Pain Management Options = | = Promising Practices for Health Plans to Support Alternate Pain Management Options = | ||
| − | + | One factor that contributes to prescription of opioids versus other options for pain management is that insurance companies often have more barriers, like, to pay for less addictive and sometimes more expensive options for pain management. When it is easier to get reimbursed for prescribing opioids, it is not surprising that doctors use that option more. Working with insurance companies to pay for less addictive options could help reduce the over-prescription of opioids. The following are examples of practices or policies that insurance companies could adopt. | |
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= Tapering off Opioid Use = | = Tapering off Opioid Use = | ||
| − | + | Tapering is important to help people ease off the use of opioid pain medication so that prescriptions can be reduced and the likelihood of misuse or addiction goes down.<br/> The COAT program developed by Essentia Health is a good example of a Tapering program. Link to [https://www.minnpost.com/mental-health-addiction/2016/05/northern-minnesota-coat-program-aims-reduce-opioid-addiction Article] | |
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= Acupuncture = | = Acupuncture = | ||
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= Medical Marijuana = | = Medical Marijuana = | ||
| − | + | A 2016 survey from University of Michigan researchers, published in the The Journal of Pain, found that chronic pain suffers who used cannabis reported a 64 percent drop in opioid use as well as fewer negative side effects and a better quality of life than they experienced under opioids.<sup class="reference">[6]</sup> | |
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| − | + | Another study found annual opioid overdose deaths to be about 25 percent lower on average in states that allowed medical cannabis compared with those that did not.<sup class="reference">[7]</sup> | |
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| − | + | University of New Mexico researchers say the legal availability of medical marijuana has the potential to reduce opioid use among chronic pain patients.<br/> The results indicate a strong correlation between enrollment in New Mexico's medical marijuana program and cessation or reduction of opioid use.<br/> The study tracked 37 habitual opioid using, chronic pain patients who enrolled in the state medical marijuana program between 2010 and 2015, compared to 29 patients with similar health conditions who didn't enroll. As of October, more than 44,000 people were enrolled in the state program. <sup class="reference">[8]</sup> | |
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| − | + | On average, physicians in states with medical cannabis prescribed 1,826 fewer painkiller doses for Medicare patients in a given year—because seniors turned to medical cannabis instead of opioids.<sup class="reference">[9]</sup><br/> | |
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= Nabiximol = | = Nabiximol = | ||
| − | + | Nabiximol is an oral cannabinoid spray used for treating chronic pain that is currently legal in 29 countries, but not the United States. | |
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*During a two week trial in European hospice care, researchers found significant success in sustaining the painkilling properties of Nabiximol without having to escalate the dose | *During a two week trial in European hospice care, researchers found significant success in sustaining the painkilling properties of Nabiximol without having to escalate the dose | ||
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#[https://www.usnews.com/news/best-states/new-mexico/articles/2017-11-27/unm-study-medical-marijuana-an-alternative-for-opioids [5]] | #[https://www.usnews.com/news/best-states/new-mexico/articles/2017-11-27/unm-study-medical-marijuana-an-alternative-for-opioids [5]] | ||
#[http://content.healthaffairs.org/content/35/7/1230 [6]] | #[http://content.healthaffairs.org/content/35/7/1230 [6]] | ||
| − | </div> </div> </div> | + | </div> </div> </div> </div></div> |
Revision as of 22:40, 29 November 2018
Return to Opioid Top-Level Strategy Mapor Zoom Map (Reduce Access to Opioids)or Zoom Map (Minimize Desire to Misuse Opioids)
Objective Page (Reduce Prescription of Opioids)Return to Partner Roles: Health Plans
Contents
- 1 Acute vs. Chronic Pain
- 2 Non-opioid treatment[4]
- 3 Costs of Chronic Pain
- 4 Promising Practices for Health Plans to Support Alternate Pain Management Options
- 5 Tapering off Opioid Use
- 6 Acupuncture
- 7 Medical Marijuana
- 8 Nabiximol
- 9 Inspiring Examples
- 10 Tools & Resources
- 11 Scorecard Building
- 12 Resources to Investigate
- 13 Sources
(Note: This Objective from the Minimize the Desire to Misuse Opioids/Protective Factors map should be merged with the one on the Reduce Prescriptions Map.)
Acute vs. Chronic Pain
Acute pain results from disease, inflammation, or injury to tissue and comes on suddenly, subsiding once the tissue heals. [1]
Chronic pain is pain that persists for three months or more and is outside of active cancer or end-of-life pain. [2]
- More than 100 million Americans suffer from chronic pain.[3]
Non-opioid treatment[4]
In addition to the pain itself, chronic pain involves sleeplessness, an inability to remain active, and anxiety, which can also affect the person's relationships. Non-opioid approaches not only reduce pain but can also address those other aspects of chronic pain like quality of life. Some other recommended options include Cognitive Behavior Therapy (CBT), Quell.
- Quell is a wearable technology that uses an electrical stimulator to trigger your brain to release enkephalins, a natural pain blocking molecule. It also contains a sleep tracker to help you understand your disease and its impact on rest.
Costs of Chronic Pain
- Chronic pain costs Americans more than $635 billion per year.[5]
Promising Practices for Health Plans to Support Alternate Pain Management Options
One factor that contributes to prescription of opioids versus other options for pain management is that insurance companies often have more barriers, like, to pay for less addictive and sometimes more expensive options for pain management. When it is easier to get reimbursed for prescribing opioids, it is not surprising that doctors use that option more. Working with insurance companies to pay for less addictive options could help reduce the over-prescription of opioids. The following are examples of practices or policies that insurance companies could adopt.
Tapering off Opioid Use
Tapering is important to help people ease off the use of opioid pain medication so that prescriptions can be reduced and the likelihood of misuse or addiction goes down.
The COAT program developed by Essentia Health is a good example of a Tapering program. Link to Article
Acupuncture
- community acupuncture: low cost?
Medical Marijuana
A 2016 survey from University of Michigan researchers, published in the The Journal of Pain, found that chronic pain suffers who used cannabis reported a 64 percent drop in opioid use as well as fewer negative side effects and a better quality of life than they experienced under opioids.[6]
Another study found annual opioid overdose deaths to be about 25 percent lower on average in states that allowed medical cannabis compared with those that did not.[7]
University of New Mexico researchers say the legal availability of medical marijuana has the potential to reduce opioid use among chronic pain patients.
The results indicate a strong correlation between enrollment in New Mexico's medical marijuana program and cessation or reduction of opioid use.
The study tracked 37 habitual opioid using, chronic pain patients who enrolled in the state medical marijuana program between 2010 and 2015, compared to 29 patients with similar health conditions who didn't enroll. As of October, more than 44,000 people were enrolled in the state program. [8]
On average, physicians in states with medical cannabis prescribed 1,826 fewer painkiller doses for Medicare patients in a given year—because seniors turned to medical cannabis instead of opioids.[9]
Nabiximol
Nabiximol is an oral cannabinoid spray used for treating chronic pain that is currently legal in 29 countries, but not the United States.
- During a two week trial in European hospice care, researchers found significant success in sustaining the painkilling properties of Nabiximol without having to escalate the dose
Inspiring Examples
Kaiser Permanente's Integrated Pain Service
- An eight-week course designed to educate high-risk opioid patients about pain management, available to Kaiser Permanente members in Colorado for $100.
- Helps patients use alternatives to drugs like exercise, meditation, acupuncture and mindfulness. Also has a chemical dependency unit to deliver medication-assisted treatment for patients with opioid addiction.
- Patient care teams are comprised of: doctors, clinical pharmacists, mental health therapists, physical therapists, and nurses, all on one floor - patients can meet with this team either all at once or in groups. This avoids needing to obtain referrals and schedule individual appointments scattered across different facilities.
- Results: Kaiser researchers tracked more than 80 patients over the course of a year and found the group's ER visits decreased 25 percent. Inpatient admissions dropped 40 percent and patients' opioid use went way down.
- Challenges: Universal implementation due to the program's scale. Big systems like Kaiser have ample resources and can afford to run programs like this, but smaller fragmented systems don't. Payment can also be challenging, as some insurers won't pay for alternative treatments, others have separate payment streams for different kinds of care. Often, behavioral health and medical health are paid for by entirely different systems. Policy to overcome these challenges is needed.
Source: [1]
Tools & Resources
TR - Expand Programs & Options for Chronic Pain Management
Scorecard Building
Potential Objective Details
Potential Measures and Data Sources
Potential Actions and Partners
Resources to Investigate
More RTI on Chronic Pain Management
PAGE MANAGER: [insert name here]
SUBJECT MATTER EXPERT: [fill out table below]
| Reviewer | Date | Comments |
Sources
- Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.
- Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.
- Institute of Medicine Committee on Advancing Pain Research, Care, and Education, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research (Washington D.C.: National Academies Press, 2011), 1.
- ==
==
A. Sass, "Exploring New Technological Developments in Chronic Pain Management," March 2017, Mediaplanet. - A. Bostic and J. Matney, “Reducing Opioid Risk with SBIRT,” webinar, April 9, 2014, [2] opioidssbirt.htm.
- [3]
- [4]
- [5]
- [6]
