National Academies Press: OpenBook
« Previous: 7 Policies to Address Barriers to the Use of Evidence-Based Nonpharmacological Approaches to Pain Management
Suggested Citation:"8 Future Directions." 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 77
Suggested Citation:"8 Future Directions." 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 78
Suggested Citation:"8 Future Directions." 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 79
Suggested Citation:"8 Future Directions." 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 80

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

8 Future Directions Highlights • To address the education gap regarding pain and pain manage- ment, efforts are underway to improve pain curricula, expand the workforce in critical areas, and change licensure and accreditation policies (Cherkin). • To make it easier for clinicians to provide nonpharmacological care, models to remove cost and access barriers and provide sup- port for clinicians are being studied (Cherkin). • Pilot studies are underway to evaluate the effectiveness of multi- modal treatments, and pragmatic studies and big data approaches will also likely be needed (Elton, Kligler). • Potential next steps include identifying actions that would have the greatest impact, developing a strategy to implement those ac- tions, designing a national public education campaign on pain and pain management, and engaging with companies moving into the health care field (Anderson, Goldblatt, Schoomaker). NOTE: These points were made by the individual speakers identified above; they are not intended to reflect a consensus among workshop participants. Daniel Cherkin suggested in his concluding remarks that the field is in the midst of moving “from a thousand points of blight to a thousand points of light.” The points of blight are well recognized, he said, including the tremendous toll of the opioid epidemic, the continued suffering of peo- ple in pain despite the availability of treatment approaches that can relieve suffering, inadequate clinician training, poor understanding of evidence 77 PREPUBLICATION COPY: UNCORRECTED PROOFS

78 NONPHARMACOLOGICAL APPROACHES TO PAIN MANAGEMENT regarding pain treatment effectiveness, continued focus on a biomedical rather than biopsychosocial approach to treating pain, poor access to ef- fective nonpharmacological care, inadequate coverage of nonpharmaco- logical treatments, and a shortage of qualified clinicians to deliver those treatments. The cost of continued inaction is high, Cherkin said as he shifted his attention to the thousand points of light. First, he said, recognition of the essential role of education has resulted in efforts to improve pain curricula with a focus on team and collaborative care, expand the workforce in crit- ical areas, and change licensure and accreditation policies. In addition, models are being developed to remove cost and access barriers and provide systems support to make it easier for clinicians to provide nonpharmaco- logical care. Finally, many agencies are increasing research funding dedi- cated to improving the management of pain. Cherkin also highlighted the increasing focus on patients at the center of care management and the im- portance of empowering patients and supporting self-management. Eric Schoomaker added that although people in the conventional health care world might see efforts to expand the use of complementary and integrative health approaches as an attempt to build an alternative uni- verse, in reality the aim is to integrate emerging disruptive technologies, some of which are 4,000 years old, into conventional practice. POTENTIAL OPPORTUNITIES FOR MOVING FORWARD Cherkin predicted that the workshop would imbue participants with energy and confidence to take their good work in this area to the next level, knowing that they can call on other participants for advice, support, and collaboration. Anthony Delitto agreed, adding that workshop participants are already implementing many new ideas in the classroom, clinic, and community. Emerging models are ready for prime time, said Delitto, add- ing that he would like to see simulations give way to real-world studies in community environments. David Elton noted that many innovative pilot studies are underway that are driven by employers. For example, some studies evaluating virtual reality with biofeedback in the office and at home to control pain (Gupta et al., 2018). Biometric data collected indicated that participants experi- enced better pain control and improved function at very low cost, he said. Benjamin Kligler commented that pragmatic data and a big data ap- proach will be needed to evaluate some combinations of approaches, such PREPUBLICATION COPY: UNCORRECTED PROOFS

FUTURE DIRECTIONS 79 as cognitive behavioral therapy plus acupuncture plus yoga, because it is unlikely that anyone would conduct a clinical trial to assess effectiveness of that combination. Elton said Optum Labs is working in this space to bring all stakeholders together with academic and industry researchers and provide data access to begin answering these kinds of questions. Margaret Chesney added that leveraging datasets in existing studies may also pro- vide a head start in efforts to fill research gaps. Another issue related to understanding the effectiveness of combined therapeutic approaches was raised by Elizabeth Goldblatt. When people experience difficult chronic pain, they frequently see multiple practition- ers who may or may not be working together as a team. It is vitally im- portant that health professionals communicate with one another to provide optimal care, she added. Roger Chou said there have been studies of coor- dinated care models at the Department of Veterans Affairs (VA); although implementing these models outside of VA settings has proven difficult. Elton said data from his large network suggests there are pockets of inno- vation where diverse providers are working together in natural networks to provide tightly integrated care. These approaches can be powerful, he said, but may be challenging to scale up in health systems where providers operate in silos. Cherkin suggested convening a task force to identify key actions that would have the biggest, broadest, and quickest impact on removing major barriers, and then crafting a strategy to address those issues. Schoomaker agreed, adding that a campaign plan is needed to clearly define lines of efforts and principal tasks. A national campaign should include a substan- tial amount of public education, added Goldblatt. She and Belinda Anderson suggested reaching out and engaging big technology companies that are moving into the health care field in these efforts. In the closing moments of the workshop, David Shurtleff urged work- shop participants to take advantage of the major programs and initiatives already in place to help move these ideas forward.1 1Shortly after this workshop, 30 new funding opportunities aimed at evaluating the full spectrum of strategies for pain management were announced as part of the NIH HEAL Initi- ative. For more information on the NIH HEAL funding opportunities, go to https://www.nih. gov/about-nih/who-we-are/nih-director/statements/nih-needs-your-innovative-research- ideas-through-our-newly-announced-nih-heal-initiative-funding-opportunities (accessed Feb- ruary 7, 2019). PREPUBLICATION COPY: UNCORRECTED PROOFS

Next: Appendix A: References »
The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop Get This Book
×
Buy Paperback | $50.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

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.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!