HHS Inter-Agency Task Force on Pain Management Attracts Controversy

By: Mario Ramirez, MD

Reading Time: 3 minutes

Date: 03/28/2019

Filed Under: Pain Management, regulations

 

Task Force Releases Draft Report

The Comprehensive Addiction and Recovery Act of 2016 established a Pain Management Best Practices Inter-Agency Task Force, chaired by Dr. Vanila Singh, under the oversight of the U.S. Department of Health and Human Services.

The Task Force is made up of representatives from across HHS, the Departments of Veterans Affairs and Defense, the Office of National Drug Control Policy, and non-federal representatives from experts and stakeholder groups. It is charged with delivering their final report to Congress in 2019, but released their draft findings in early January this year. The report is open for a 90-day comment and public input period before the draft will be revised and submitted to Congress later this year.

Summarizing the report, Healio Primary Care Today[1] highlighted the key recommendations:

  • Taking a balanced pain management, “biopsychosocial model” of care to manage pain
  • Improving opioid stewardship through risk assessments based on the patient’s medical, family, and social histories
  • Improving understanding of pain mechanisms and the use of innovative medical devices and medications to alleviate the acute-to-chronic pain transition
  • Focusing research on methods to improve outcomes of chronic pain conditions
  • Using empathetic approaches to reduce the stigma that is often a barrier to treatment
  • Improving insurance coverage for alternative treatment modalities and a larger workforce of pain management specialists and those trained to treat chronic pain
  • Using multidisciplinary approaches to chronic pain that take a whole-of-patient approach and incorporate behavioral and psychosocial interventions
  • Using perioperative guidelines that provide a framework for post-intervention pain management
  • Improving education and training to facilitate societal and patient awareness about opioid management and addiction

Pain Management Task Force Controversial Conclusions

Practical Pain Management also highlighted some critical conclusions by the Task Force that have generated some controversy[2].  Specifically:

  • Aggressive marketing of new opioid products, while limiting coverage for other pain management options, could add to the climate of opioid addiction.
  • The effect of electronic health records may be contributing to “physician burnout and lowered…ability of physicians to focus and care for the complexities of pain.”
  • The unintended effects of state PDMP programs which have caused some clinicians to incorrectly overlay CDC guidelines on opioid prescribing and thereby restrict patients supplies. This has, in turn, reportedly caused some patients to seek illicit supplies or illegal drugs including fentanyl and heroin.

This last point was covered by several stakeholders who felt that the Task Force’s recommendations were implicitly critical of the 2016 CDC Guidelines on Opioid Prescribing. Orthopedics This Week highlighted some of these criticisms of the CDC recommendations by the Task Force[3].

  • Limitations in expert selection and evidence criteria that were used to formulate the 2016 Guidelines
  • That the CDC illogically condemned opioid medications based on erroneous criteria around the opioid clinical trials used to formulate their guidelines
  • That the CDC’s recommendation to limit most prescriptions to three days was overly restrictive and that a more balanced approach was necessary to preserve the patient physician relationship
  • Finally, the Task Force noted the rising rates of suicide among patients with chronic pain increased from 7.4% in 2003 to 10.2% in 2014 and leads “to the rising concern that a recent trend of health care professionals opting out of treating pain has contributed to an existing shortage of pain management specialists and is leaving some patients without adequate access to care.[4]

Key Takeaway

Although the draft report made only a quiet splash when it was released earlier this year, it is likely to receive greater attention when the final report is submitted to Congress later this year. In a space that has become politically charged, the Task Force's recommendations, particularly those critical of the CDC, are sure to be framed through certain political lenses. Affirmhealth will keep an eye on these developments to keep you updated and help you make your own informed decisions.

 

Sources:

[1] https://www.healio.com/family-medicine/pain-management/news/online/%7B53ad999f-3674-47a9-b13e-f2a520b433e6%7D/hhs-task-force-outlines-best-practices-for-pain-management-seeks-input

[2] https://www.practicalpainmanagement.com/resources/news-and-research/hhs-inter-agency-task-force-urges-new-ways-limit-opioid-use-addiction

[3] https://ryortho.com/breaking/draft-federal-report-slams-cdc-opioid-policies/

[4] https://www.hhs.gov/ash/advisory-committees/pain/reports/2018-12-draft-report-on-updates-gaps-inconsistencies-recommendations/index.html

 

 

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