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Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
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B

Workshop Agenda

The Role of Nonpharmacological Approaches to Pain
Management—A Workshop

December 4–5, 2018
National Academy of Sciences Building
2101 Constitution Avenue, NW, Washington, DC

Background:

Pain is a leading cause of disability in the United States. Given the complexity and biobehavioral nature of pain, the 2011 Institute of Medicine report Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research advocated for multifaceted approaches for pain management composed of both pharmacological and nonpharmacological therapies. In 2017, the National Academies of Sciences, Engineering, and Medicine’s report Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use reviewed the status of available evidence on nonpharmacological therapies for managing chronic pain. For example, cognitive behavioral therapy (CBT), a type of psychotherapy focused on restructuring negative thoughts and experiences with positive expectations, has been shown to be effective in reducing pain intensity and other psychological effects caused by pain (e.g., anxiety and depression) for low back pain, headaches, arthritis, orofacial pain, and fibromyalgia.

As a result of this national push toward the use of nonpharmacological therapies for chronic pain, increased health professional education and train-

Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×

ing will be needed to encourage the adoption and appropriate use of the evidence-based approaches. In addition, addressing policy barriers, such as those related to reimbursement for these treatments, will be important to enable broader use and dissemination. Given the changing landscape for pain management, the Forum on Neuroscience and Nervous System Disorders and the Global Forum on Innovation in Health Professional Education will bring together key stakeholders to discuss these treatments and integrative health models for pain management.

Workshop Objectives:

  • Review the current state of evidence on the effectiveness of nonpharmacological treatments and integrative health models for pain management as well as available evidence on use patterns and patient interest. Examples may include acupuncture; manual therapies; physical therapy, occupational therapy, and exercise; cognitive behavioral therapy; tai chi; yoga; meditation; and neurostimulation.
  • Explore the state of evidence on the effectiveness of emerging models of pain management.
  • Consider multimodal approaches and potential synergies between and among pharmacological and nonpharmacological approaches to pain management.
  • Consider multimodal approaches and potential synergies between and among devices and nonpharmacological approaches to pain management.
  • Discuss research gaps and key questions for further research.
  • Examine health professions’ current approaches for educating students, trainees, and practicing clinicians on nonpharmacological pain management, and discuss potential next steps to improve training and education within and across health professions.
  • Explore policies, such as those related to reimbursement that would enable broader dissemination and implementation of evidence-based nonpharmacological treatments when appropriate.
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×

DAY ONE: December 4, 2018

8:00 a.m. Welcome and Overview of Workshop

DANIEL CHERKIN (Co-Chair), Kaiser Permanente Washington Health Research Institute (Emeritus)

ANTHONY DELITTO (Co-Chair), University of Pittsburgh

8:15 a.m. Why This Workshop Matters: Lived Experience and Provider Perspective

CHRISTIN VEASLEY, Chronic Pain Research Alliance

MARK RYAN, Virginia Commonwealth University

Objectives:

  • Describe the treatments used for pain problems covered by insurance and patient use of complementary and integrative health approaches often not covered by insurance.
  • Review evidence for the effectiveness and cost-effectiveness of nonpharmacological treatments for pain management.
  • Describe the impact of psychological and social factors on patient responses to pain and pain treatments.
  • Explore the state of evidence on the effectiveness of emerging models of pain management.
  • Consider multimodal approaches and potential synergies between and among (1) pharmacological and nonpharmacological approaches; and (2) devices and nonpharmacological approaches to pain management, and for whom.
  • Discuss research gaps and priorities for further research.
8:35 a.m. Session Overview

STEVEN GEORGE, Duke University (Moderator)

8:45 a.m. What health care services are provided to persons with pain?
  • In large insured population
  • In indigent (Medicaid) population
  • In older adults (Medicare)
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
  • Use of complementary and integrative health approaches in the U.S. population

DAVID ELTON, Optum

9:00 a.m. What do we know about the effectiveness and safety of nonpharmacological and nonsurgical treatments for chronic pain conditions?
  • Low back pain
  • Other common pain problems
  • In specific populations (indigent, elderly, ethnic groups)

ROGER CHOU, Oregon Health & Science University

9:30 a.m. What is known about the cost-effectiveness of nonpharmacological and nonsurgical treatments?

PATRICIA HERMAN, RAND Corporation

9:45 a.m. Discussion
10:15 a.m. BREAK
10:30 a.m. What are the effects of psychological and social factors on patient responses to pain and pain treatments?

DENNIS TURK, University of Washington

10:45 a.m. Emerging Models of Care
Overview (deficiencies of current models; principles guiding development of new models; evidence for effectiveness of major models; and challenges for implementing in diverse settings)

ROBERT KERNS, Yale University (Moderator)

11:00 a.m. Major Models and Evidence for Effectiveness
Stepped Care, Stratified Care, and Matched Care

WILLIAM SHAW, University of Connecticut

First Contact Care

JULIE FRITZ, University of Utah

Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
Care for Patients with Complex and High-Impact Chronic Pain

ROBERT EDWARDS, Brigham and Women’s Hospital/Harvard Medical School

Integrative Care

LYNN DEBAR, Kaiser Permanente Washington Health Research Institute

Use of Technology to Support Access, Self-Management, and Care Processes

ALICIA HEAPY, Yale University; VA Connecticut Healthcare System

11:50 a.m. Discussion
12:30 p.m. LUNCH
1:30 p.m. Multimodal Approaches to Pain Management and Potential Synergies
Pharmacological and Nonpharmacological Approaches

KURT KROENKE, Indiana University

Devices and Nonpharmacological Approaches

RICHARD WILSON, Case Western Reserve University

2:00 p.m. Discussion
2:15 p.m. Major Current Research Initiatives and Priorities

LINDA PORTER, National Institute of Neurological Disorders and Stroke

DAVID SHURTLEFF, National Center for Complementary and Integrative Health

WENDY SMITH, National Institutes of Health Office of Behavioral and Social Sciences Research

ALISON CERNICH, National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute of Child Health and Human

Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×

Development

CHRISTINE GOERTZ, Patient-Centered Outcomes Research Institute (PCORI)

DAVID ATKINS, Department of Veterans Affairs

ERIC SCHOOMAKER, Uniformed Services University of the Health Sciences, Department of Defense

3:05 p.m. Panel on Future Research Priorities

ALICIA HEAPY, Yale University; VA Connecticut Healthcare System

ROGER CHOU, Oregon Health & Science University

PATRICIA HERMAN, RAND Corporation

KAREN SHERMAN, Kaiser Permanente Washington Health Research Institute

BEVERLY THORN, University of Alabama

3:30 p.m. Discussion
Discussant: KIM DUNLEAVY, University of Florida
4:00 p.m. BREAK

Objective:

  • Examine health professions’ current approaches for educating students, trainees, and practicing clinicians on nonpharmacological pain management.
4:15 p.m. Session Overview

ELIZABETH (LIZA) GOLDBLATT, Academic Collaborative for Integrative Health (Moderator)

4:25 p.m.

Current Status of Health Professional Education in Pain

Management and the Incorporation of Nonpharmacological Approaches

SCOTT FISHMAN, University of California, Davis

4:40 p.m. Discussion
Discussants: NANCY BAKER, Tufts University
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×

DAVID THOMAS, National Institute on Drug Abuse

BENJAMIN KLIGLER, Veterans Health Administration; Icahn School of Medicine at Mount Sinai

5:30 p.m. Adjourn Day One

DANIEL CHERKIN (Co-Chair), Kaiser Permanente Washington Health Research Institute (Emeritus)

ANTHONY DELITTO (Co-Chair), University of Pittsburgh

DAY TWO: December 5, 2018

8:00 a.m. Day Two Opening Remarks

DANIEL CHERKIN (Co-Chair), Kaiser Permanente Washington Health Research Institute (Emeritus)

ANTHONY DELITTO (Co-Chair), University of Pittsburgh

Objective:

  • Discuss potential next steps to improve training and education for pain management within and across health professions.
8:10 a.m. Session Overview

ELIZABETH (LIZA) GOLDBLATT, Academic Collaborative for Integrative Health (Moderator)

8:20 a.m.

Interprofessional Education: How do we move from classroom to practice?

MICHELE MAIERS, Northwestern Health Sciences University (Topic Moderator)

Speakers:

JUDY WATT-WATSON, University of Toronto

S. LIZ HARRELL, Arizona State University

8:50 a.m. Discussion

Discussant: BENJAMIN KLIGLER, Veterans Health Administration; Icahn School of Medicine at Mount Sinai

Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
9:30 a.m. BREAK
9:45 a.m.

Collaborative Practice: Facilitating a Team-Based Approach for Pain Management

MARGARET CHESNEY, University of California, San Francisco (Topic Moderator)

Speakers:

LESLIE DAVIDSON, The George Washington University

ANTHONY LISI, Veterans Health Administration; Yale School of Medicine

10:15 a.m. Discussion

Discussant: BELINDA (BEAU) ANDERSON, Monmouth University; Albert Einstein College of Medicine

11:00 a.m. LUNCH

Objectives:

  • Explore policies, such as those related to reimbursement, that would enable broader dissemination and implementation of evidence-based nonpharmacological treatments when appropriate.
  • Discuss potential policy barriers and opportunities for innovation.
  • Consider the research and evidence needed to advance these policies.
12:00 p.m. Session Overview

ROBERT SAPER, Boston University (Moderator)

What policies would help reduce major barriers to change?

12:10 p.m.

Patient, Clinician, Educator, and Health Care System Perspectives

PENNEY COWAN, American Chronic Pain Association

ROBERT BONAKDAR, Scripps

Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×

BETH DARNALL, Stanford University

DANIEL CARR, Tufts University School of Medicine

HARLEY GOLDBERG, Kaiser Permanente (retired)

CHESTER (TRIP) BUCKENMAIER III, Uniformed Services

University of the Health Sciences, Department of Defense

12:40 p.m. Discussion
12:55 p.m.

Insurance Coverage and Reimbursement Perspective

SHARI LING, Centers for Medicare & Medicaid Services

CATHERINE LIVINGSTON, Health Evidence Review Commission/Oregon Health Authority

DAVID ELTON, Optum

CALEB ALEXANDER, Johns Hopkins University

PATRICIA HERMAN, RAND Corporation

1:20 p.m. Discussion

Objective:

  • Synthesize and discuss key highlights from the workshop presentations and discussions and, most importantly, identify next steps and promising areas for future action and research.
1:40 p.m.

Session Overview and Synthesis of Key Workshop Themes

DANIEL CHERKIN (Co-Chair), Kaiser Permanente Washington Health Research Institute (Emeritus)

ANTHONY DELITTO (Co-Chair), University of Pittsburgh

2:00 p.m. Open Discussion
2:25 p.m.

Closing Remarks from the Workshop Co-Chairs

2:30 p.m. Adjourn Workshop
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×

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Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
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Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
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Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
Page 93
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
Page 94
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
Page 95
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
Page 96
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
Page 97
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
Page 98
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
Page 99
Suggested Citation:"Appendix B: Workshop Agenda." National Academies of Sciences, Engineering, and Medicine. 2019. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25406.
×
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Pain is a leading cause of disability globally. The dramatic increase in opioid prescriptions within the past decade in the United States has contributed to the opioid epidemic the country currently faces, magnifying the need for longer term solutions to treat pain. The substantial burden of pain and the ongoing opioid crisis have attracted increased attention in medical and public policy communities, resulting in a revolution in thinking about how pain is managed. This new thinking acknowledges the complexity and biopsychosocial nature of the pain experience and the need for multifaceted pain management approaches with both pharmacological and nonpharmacological therapies.

The magnitude and urgency of the twin problems of chronic pain and opioid addiction, combined with the changing landscape of pain management, prompted the National Academies of Sciences, Engineering, and Medicine to convene a workshop on December 4–5, 2018, in Washington, DC. The workshop brought together a diverse group of stakeholders to discuss the current status of nonpharmacological approaches to pain management, gaps, and future directions. This publication summarizes the presentations and discussions from the workshop.

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