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Chronic Pain & Opioid Addiction: The Role of Integrated Care

September 21, 2017
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Pain is a part of every human being’s experience. And whether it’s short-term acute pain relating to an injury or long-term chronic pain that continues after an injury has healed, effectively managing pain is a key goal for the American health care system. As our country faces an unprecedented opioid epidemic – on average each day in the United States 650,000 opioid prescriptions are dispensed[1] and 78 people die from an opioid-related overdose[2] – it is incumbent on health care institutions and professionals to find better approaches to lessening suffering and improving quality of life for those who have chronic pain.

To discuss this challenge, the Alliance for Health Policy hosted a policy briefing last week, titled “Chronic Pain & Opioid Addiction: The Role of Integrated Care.” Panelists from academic, clinical, foundation and payer backgrounds shared their thoughts on how integrated health care approaches can address the root causes of the opioid epidemic – chronic pain – and not just its symptoms – opioid addiction.

Treating Patients Holistically

For the 25.3 million Americans who are living with daily pain[3] -- many of whom are using prescription opioids -- there are often a variety of conditions and treatments that make up their diagnoses and care plans. The traditional health care model encourages specialization, requiring a patient to see multiple providers to treat various aspects of their mental and physical health, rather that treating them holistically. This model can put strain on the patient, requiring more time and money, and typically leading to poorer outcomes.

By contrast, integrated health care promotes collaboration and secure information sharing among providers so treatment can be considered as part of a holistic health plan, rather than in a vacuum. An integrated health care approach also looks beyond a patient’s mental or physical symptoms to include social factors that impact health such as having a safe place to live and exercise, healthy food to eat and access to transportation to get medical care. Chronic pain rarely exists alone; it often exists in a co-morbid state with other medical and psychological conditions. In fact, one study found that 90 percent of patients who experience chronic pain also experience some level of psychological distress.[4]

To facilitate an integrated health care approach that treats patients holistically, panelists discussed several strategies.

  • Creating a national standard for pain to be used across specialties: Current pain scales are often subjective, and do not take into account how pain impacts a person’s ability to live their life. Treatment models should be different depending on the nature of a patient’s pain, and properly diagnosing it is an important first step.
  • Educating primary care providers about what opioid failure looks like: Rather than segmenting behavioral health or substance abuse counseling from primary care, providers on the front lines of public health should be included in conversations about how to assess if an opioid is an appropriate course of treatment, and how to identify if that treatment is not achieving the treatment goals.
  • Considering alternate evidence-based therapies: If an opioid treatment is not improving a patient’s quality of life, or if that patient is at risk of addiction, providers should consider how alternate evidence-based therapies might address the problem as a whole. These could include buprenorphine, medication-assisted therapy, counseling, acupuncture or others. Similarly, for those patients for whom opioids are a successful treatment, co-prescribing naloxone can improve patient safety.

Transitioning to Value-Based Payment Models

The panelists shared that these approaches are best supported by a payment model that rewards health care providers for improving patients’ quality of life, rather than a model that provides a fee for each service rendered, suggesting that these alternative payment models be flexible, individualized, adhere to clinical guidelines and have transparent metrics. By adjusting payments to incentivize quality of care over volume of care, the panelists encouraged a culture that supports integrated health care approaches. 

In order to stem the devastating effects of the opioid epidemic, the health care system must embrace new models that better treat the epidemic’s underlying cause: chronic pain. By treating patients holistically and transitioning to value-based payment models, we can make a difference in the lives of the millions of people who look to health care professionals to manage their pain and improve their quality of life.

Learn more about national trends in long-term use of prescription opioids.

 

[1] IMS Health National Prescription Audit

[2] CDC National Vital Statistics System

[3] Journal of Pain: Estimates of Pain Prevalence and Severity in Adults in the United States

[4] Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6(6):432-442; Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005;6(2):107-112.

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