A pain task force within the U.S. Department of Health and Human Services (HHS) issued a draft report addressing best practices for pain management, including acute and chronic pain, and the recommendations include leveraging innovative solutions to pain management such as telemedicine as well improving prescription drug monitoring programs (PDMPs).
The Comprehensive Addiction and Recovery Act (CARA) of 2016 led to the creation of the Pain Management Best Practices Inter-Agency Task Force, a 29-member group whose mission is to determine whether gaps in or inconsistencies between best practices for acute and chronic pain management exist and to propose updates and recommendations to those best practices. The task force members have experience across the disciplines of pain management, patient advocacy, substance use disorders, mental health, and minority health.
The draft report describes preliminary recommendations, which will be finalized and submitted to Congress later in 2019.
The task force’s recommendations focus on providing balanced pain management, based on a biopsychosocial model of care, as well as individualized, patient-centered care.
The recommendations also touch on a number of health IT tools and technologies. Industry stakeholders should focus on innovative solutions to pain management such as telemedicine, tele-mentoring, mobile apps for behavioral and psychological skills, newer medicines, and medical devices should be utilized as part of the overall approach to pain management, the task force recommends.
The task force also examined PDMPs, noting that these electronic databases can support safe prescribing and dispensing practices and help curb opioid prescription by detecting patterns that can alert clinicians to the potential that patients are at risk of SUD. However, there is a need to enhance and modernize PDMP functionality.
The task force identified a number of gaps, such as PDMP use varies greatly across the United States, with variability in PDMP design, the state’s health information technology infrastructure and current regulations on prescriber registration, access and use. Among the recommendations to address this gap, the task force calls for providers to check PDMPs, in conjunction with other risk stratification tools, upon initiation of opioid therapy, with periodic reevaluation.
Healthcare organization also should provide clinician training on accessing and interpreting PDMP data. Physicians and other health care providers should engage patients to discuss their PDMP data rather than making a judgment that may result in the patient not receiving appropriate care, according to the task force. “PDMP data alone is not error proof and should not be used to dismiss patients from clinical practices,” the task force wrote in its recommendations.
Despite the growing movement to mandate PDMP use, the task force does not support mandated use of PDMPs. Rather, the task force recommends that the health care provider team should determine when to use PDMP data. “PDMP use should not be mandated without proper clinical indications to avoid unnecessary burden in the inpatient setting,” the task force wrote.
The task force also recommends that electronic health record (EHR) vendors should work to integrate PDMPs into their system design at minimal to no additional cost to providers, to eliminate barriers to accessing PDMP data, especially when these data points are mandated.
The task force also urges increased interoperability of PDMPs across state lines to allow for more effective use.
Healthcare organizations should conduct studies to better identify where PDMP data is best used (e.g., inpatient versus outpatient settings), and adjust PDMP data use based on the findings of the recommended studies to minimize undue burdens and overutilization of resources, according to the task force’s recommendations.
