Chronic pain and care gaps in women – mahrgan

The pain management community has enough reports on gaps in pain research, access to care, and even opioids. Now is the difficult part—implementing the proposed strategies and recommendations in daily care.

  • Dr. Monica Mallampalli, Senior Scientific Advisor of HealthyWomen, currently the head of the Chronic Pain Advisory Committee
  • Sean Mackey, MD, Director of Pain Medicine, Stanford University
  • Cindy Steinberg, Director of National Policy and Advocacy, American Pain Foundation
  • Christin Veasley, co-founder and director of the Chronic Pain Research Alliance

The core elephant in the virtual room is why there is still Not enough high-quality data on chronic pain experience to let patients understand their disease and allow clinicians to adequately treat the disease? Also, how about the multiple reports generated so far (see below) Can you help pain clinics and patients in need in terms of pain research, care and management? The panelists reviewed what has been checked so far and how far we need to go to provide adequate care.

  • National Pain Care Policy Act of 2003 (introduced in 2003 but never fully passed; partly introduced in the Affordable Care Act of 2010)
  • The 2011 IOM (now the National Academy of Sciences, the Academy of Engineering, and the School of Medicine) report related to the 2016 National Pain Strategy (NPS), which was formulated in accordance with Recommendation 2-2 of the IOM report (Disclosure: Dr. Mackey and Ms. Veasley are members of the supervisory committee)
  • 2017 Federal Pain Research Strategy
  • 2019 HHS Interdepartmental Pain Management Working Group Report, led by Vanila A. Singh, MD

Here are some brief highlights and a PPM Follow up with speakers.

No need for another big pain report or working group. The pain management and advocacy community knows what needs to be done-next it needs to be implemented (Image: iStock).

Chronic pain in women-takeaways from the webinar*


Enough pain reports, already

Regarding the reports cited above, Dr. Mackey pointed out that they are as relevant today as they were 10 to 15 years ago. “While some progress has been made, including terms related to high-impact chronic pain (i.e. pain interference or pain that causes severe restrictions on activities of daily living, affecting approximately 8% to 10% of chronic pain patients)-more resources are still needed. There is still a lot of work to be done to advance the national strategic goals,” he said.

Veasley commented on the Federal Pain Research Strategic Gap Analysis, noting that recommendations on basic, translational, and clinical pain research are used to guide the items included in the NIH HEAL program and its scientific recommendations. “It usually takes a lot of energy and money to develop these large reports, she pointed out, but what is needed after that is a designated institution or group, and a lot of funds to bring all necessary stakeholders together and implement them in a coordinated manner. These suggestions. Cross-system fashion… We need to change understanding, clinical behavior and attitudes, and actual implementation in a coordinated way,” she added, noting that if there is not enough back-end support, the initial focus may be wasted Lose.

“This is where we need people to speak out,” Wesley suggested. “We don’t want to pass a document to give hope to those who are suffering, and then see it being shelved. This is the message to Congress: stop power generation more Report, but take action. “

In fact, all four panelists agreed that another important pain report or working group is no need. The community knows what needs to be done-it needs to be implemented next.

Progress is progress, even if progress is slow or unexpected

Steinberg highlighted some examples of progress in the area of ​​pain, including a new set of migraine treatments (see also CGRPs) and Medicare’s recent additional coverage of acupuncture for low back pain.

In today’s mindset, Dr. Mackey refers to telemedicine as the “glitter of hope” for COVID-19-and points out that virtual doctor visits have changed cross-medicine healthcare services, including pain management. He urged clinicians to continue to promote reimbursement/payment for telemedicine, making it equivalent to future in-person care.

Remember, equal access is the key

Wesley emphasized the importance of continuing to focus on reducing differences in women’s research and care, as well as paying attention to patients of different racial/ethnic groups as well as socioeconomic and geographic groups. Currently, there is no tailor-made treatment method and a method to truly reduce nursing barriers. She called for the establishment of a new “research paradigm” always Address diversity, inclusion, and equity (DEI) in advance instead of putting it aside” or thinking after the fact, and pointed out that biological, psychological, social, and gender factors should also play a role in this transition. She pointed out that understanding personal pain Experience can lead to tailor-made solutions.

It’s time to make waves

Taking substance use disorder as an example, Dr. McGee pointed out that in recent years, the reason why state funding for addiction (think opioid use disorder, or OUD) has received so much attention in the United States is “because of the mobilization of a large number of relevant “Citizen” and opened up… “Policy makers from all over the country are yelling… If this kind of effort can be developed in the pain field,” he shared, “We can do amazing things together. Thing.”

Women and pain: where to go

Personalized pain management

PPM: In terms of future initiatives, what do you think of enriching personalized pain management in a way that suits the clinician’s office? Is this possible or a lofty goal?

Dr. Mallampalli: We must first understand the biopsychosocial model of pain and how it affects and helps personalize pain care. Provider education is important for understanding the biopsychosocial factors that affect pain. This is a lofty goal, because we do not understand all the factors that affect individual pain in the three areas, but we can begin to educate providers on the importance of providing patient care from the perspective of this model.

Wesley: This may not be an easy goal, but it is possible and is being carried out for other complex diseases (such as cancer) in which all aspects of the disease and its impact on all aspects of a person’s life Get considered and resolved through team-based care.

Collaborative pain care

PPM: It may take years to move from the workbench to the bedside, but in terms of truly transferring the needle from data to implementation, it requires many things, including clinical understanding, available treatments, care visits, communication and collaboration, funding and reimbursement . If you could provide next steps to implement existing pain strategies, what would you recommend?

Dr. Mallampalli: From the perspective of HealthyWomen, the steps taken to meet existing pain strategies include:

  • Raise public awareness of the National Pain Strategy (NPS)
  • Bringing Congress’s attention to the implementation of NPS, including necessary funding
  • Ask Congress to be accountable for the work that NIH has done so far
  • Example: After NASEM released its report on opioids, it received support from 35 cooperative organizations and established an action collaboration organization to combat the opioid epidemic, which is responsible for bringing all necessary stakeholders together to implement the report Suggestions.

Find answers in other medical fields

PPM: It was pointed out in the webinar that learning from other majors such as neurology and psychiatry can help advance some pain treatments. Are there other gaps or areas to explore in this regard?

Dr. Mallampalli: Another example is neuromodulation. Maybe we need a large database or registry to capture such information from multiple disciplines. Many of the therapies we use to treat pain are also used in other areas to treat complex brain diseases, such as depression. Drugs originally developed for other diseases are often used “off-label” to treat pain, such as TCA, SNRI, and anticonvulsants. In addition, cognitive behavioral therapy (CBT) for sleep hygiene and other behavioral therapies (for example, mindfulness, stress reduction, and relaxation therapy) may help patients with pain improve their quality of life.

See also PPM’s special report Women change painkillers.

Last update date: October 5, 2021

Call for action to help women with chronic pain

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