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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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Page 91
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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Page 92
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.
×
Page 100

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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 com- plexity and biobehavioral nature of pain, the 2011 Institute of Medicine re- port 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 nonpharmacolog- ical therapies. In 2017, the National Academies of Sciences, Engineering, and Medicine’s report Pain Management and the Opioid Epidemic: Balanc- ing 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, orofa- cial 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- 91

92 NONPHARMACOLOGICAL APPROACHES TO PAIN MANAGEMENT ing will be needed to encourage the adoption and appropriate use of the ev- idence-based approaches. In addition, addressing policy barriers, such as those related to reimbursement for these treatments, will be important to en- able 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 non- pharmacological 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 neu- rostimulation. • Explore the state of evidence on the effectiveness of emerging models of pain management. • Consider multimodal approaches and potential synergies be- tween and among pharmacological and nonpharmacological ap- proaches to pain management. • Consider multimodal approaches and potential synergies be- tween 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 nonpharmacologi- cal 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.

APPENDIX B 93 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 Pro- vider Perspective CHRISTIN VEASLEY, Chronic Pain Research Alliance MARK RYAN, Virginia Commonwealth University Session I: Nonpharmacological Approaches to Pain Management— Evidence on Effectiveness and Safety, and Emerging Models of Care Objectives: - Describe the treatments used for pain problems covered by insurance and patient use of complementary and integrative health approaches of- ten not covered by insurance. - Review evidence for the effectiveness and cost-effectiveness of non- pharmacological treatments for pain management. - Describe the impact of psychological and social factors on patient re- sponses 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)

94 NONPHARMACOLOGICAL APPROACHES TO PAIN MANAGEMENT - Use of complementary and integrative health ap- proaches in the U.S. population DAVID ELTON, Optum 9:00 a.m. What do we know about the effectiveness and safety of non- pharmacological 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 nonpharma- cological 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

APPENDIX B 95 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 Be- havioral and Social Sciences Research ALISON CERNICH, National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute of Child Health and Human

96 NONPHARMACOLOGICAL APPROACHES TO PAIN MANAGEMENT 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 Session II: Education and Training of Health Professionals in Pain Management Objective: - Examine health professions’ current approaches for educating stu- dents, 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

APPENDIX B 97 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 Session II: Education and Training of Health Professionals in Pain Management (continued) 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

98 NONPHARMACOLOGICAL APPROACHES TO PAIN MANAGEMENT 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 Session III: Policies to Promote Evidence-Based Nonpharmacological Approaches 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

APPENDIX B 99 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 Session IV: Moving Forward 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

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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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