Pain Experts Want Better Coverage for Alternative Therapies

Pauline Anderson

October 06, 2016

SAN ANTONIO — Pain management experts are getting mixed messages about treating their patients, one expert says.

On the one hand, they're told to prescribe opioids judiciously and focus more on the biopsychosocial model of care for chronic pain. On the other, alternative approaches to pain management aren't being reimbursed.

Many experts in the field expressed frustration with this state of affairs during the American Academy of Pain Management (AAPM) 2016 Annual Meeting. (The academy has recently changed its name to the Academy of Integrative Pain Management [AIPM].)

Robert Bonakdar, MD, director of pain management, Scripps Center for Integrative Medicine, La Jolla, California, broached the topic during a keynote presentation at the meeting.

Pain Initiatives

The management of pain has gained increasing attention in recent years. In 2011, the Institute of Medicine issued a report on pain, calling for tailoring pain care to each person's experience and promoting self-management of pain.

Earlier this year, the federal government released the National Pain Strategy, its first broad-ranging effort to improve how pain is perceived, assessed, and treated.

Almost at the same time, the Centers for Disease Control and Prevention announced guidelines for prescribing opioids for chronic pain, aimed at primary care providers.

And now, US Surgeon General Vivek Murthy, MD, has sent a letter to all doctors across the country urging them to pledge their commitment to "turn the tide" on the opioid crisis.

In the letter, Dr Murthy said part of the strategy to tackle the opioid epidemic, which he called an "urgent health crisis," should include screening patients for opioid use disorder and providing or connecting them with evidence-based treatments.

Clearly, the message is that to combat opioid abuse, misuse, and deterrence, clinicians should prescribe these medications with great caution and forethought.

Doctors don't disagree with the need for change in prescribing habits, Dr Bonakdar said, but they seem to be caught in a Catch-22 situation.

They are dealing with opioid restrictions while their patients can't access affordable treatments that may help their chronic pain. Many well-established nonpharmacologic treatments, such as biofeedback and cognitive-behavioral therapy (CBT), are routinely denied by insurance companies, Dr Bonakdar said.

As an ironic example of what he called the "shortcomings" of the campaign to reduce opioid prescribing, on the same day he received the Surgeon General's letter, Dr Bonakdar also received a standard letter from an insurance company denying coverage for the biofeedback he had requested for a patient's headaches.

Hisham Hakim, MD, a neurologist and the chairman and founder, American Spine Center, Birmingham, Alabama, a center specializing in nonsurgical treatment of pain, is equally frustrated. In a question-and-answer session following Dr Bonakdar's address at the meeting, Dr Hakim wondered why insurance companies are willing to approve a $1200 botulinum toxin injection to treat a migraine patient but refuse a $50 charge for acupuncture, even though the evidence for acupuncture in headaches is, to many, "irrefutable."

It's like there are two separate "silos" — one with government guidelines on opioid use and another pushing for nonpharmacologic care, said Dr Bonakdar.

"The problem is that for that second silo, we don't really have any strong government push for increased coverage, or access. We are saying 'it's a great idea, but while we lower this, how are we increasing that?'"

Things may be changing, at least in some areas. For example, starting this year, the Oregon state insurance program will cover acupuncture, CBT, and other alternative therapies, according to Dr Bonakdar.

But it's not enough. The AIPM is working on a campaign to help raise awareness in other states where insurers have "outdated laws" and deny most nonpharma care, said Dr Bonakdar.

American Academy of Pain Management 2016 Annual Meeting. Keynote presented September 23, 2016.

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