Fixing the Chronic Pain Care Catch-22

Healthcare providers in the U.S. are poorly prepared to manage chronic pain, according to the National Institutes for Health. No argument here.

Time Magazine’s Alexandra Sifferlin does an excellent job covering the January NIH report on this deepening crisis. But she ignores a crucial factor: how to pay for the interdisciplinary care that the NIH and researchers recommend.

According to the NIH, the number of opioid prescriptions for pain management in the U.S. rose to 219 in 2011, from 76 million in 1991. There are an estimated 100 million Americans who suffer from chronic pain. It’s no surprise, as the report points out, that there has been an increase in deaths related to opioid overdose.

Surprising and shocking is that opioids are the chosen treatment because most insurance plans cover these prescription drugs, but refuse coverage for other methods.

Even though the NIH recommends that the medical community adopt a multi-disciplinary approach with treatment tailored for each individual, including treatments like physical therapy and alternative modalities, we’ve allowed the healthcare system to favor the very treatment methods that make chronic pain more complicated and difficult to treat. A chronic pain care catch-22.  .

One of my colleagues reached out on twitter to respond to the report, saying, “Co-pays are prohibitive for interdisciplinary care for my patients.” Yes, they are. But, in the long-run, interdisciplinary care will reduce costs. But only if the system allows it to do so. A big part of the answer is letting public sector payers like Medicaid, Medicare and the Affordable Care Act lead the way in the same way pay-for performance is spurring hospitals to reduce patient readmission.

If the federal government does take the lead in combating this full-fledged public health crisis, no one will. Of course, enhanced systems for financing the most appropriate treatments cannot be decoupled from the need for more research that will yield new and innovative therapies that also will bring costs down.

Of course, interdisciplinary pain is not the only solution to address chronic pain, but it is an important part of the solution which nearly all experts agree is necessary, effective and important.

None of this will be easy. But, if doing the same thing over and over again has failed us, we ought to welcome this conversation to save us from systematized insanity.

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