The Role of Nonpharmacological
Approaches to Pain Management
PROCEEDINGS OF A WORKSHOP
Lisa Bain, Sheena M. Posey Norris, and Clare Stroud,
Rapporteurs
Forum on Neuroscience and
Nervous System Disorders
Global Forum on Innovation in Health Professional
Education
Board on Health Sciences Policy
Board on Global Health
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and the Academic Collaborative for Integrative Health; Academy of Nutrition and Dietetics; Accreditation Council for Graduate Medical Education; Aetna Foundation; Alzheimer’s Association; American Academy of Nursing; American Association of Colleges of Nursing; American Association of Colleges of Osteopathic Medicine; American Association of Colleges of Pharmacy; American Board of Family Medicine; American College of Obstetricians and Gynecologists; American Council of Academic Physical Therapy; American Dental Education Association; American Medical Association; American Nurses Credentialing Center; American Occupational Therapy Association; American Osteopathic Association; American Physical Therapy Association; American Psychological Association; American Speech-Language-Hearing Association; Association of American Medical Colleges; Association of American Veterinary Medical Colleges; Association of Schools and Colleges of Optometry; Association of Schools and Programs of Public Health; Association of Schools of the Allied Health Professions; Athletic Training Strategic Alliance; Cohen Veterans Bioscience; Council on Social Work Education; Department of Health and Human Services’ Food and Drug Administration (5R13FD005362-02) and National Institutes of Health (NIH) (HHSN26300001 and 75N98019F00469 [Under Master Base HHSN263201800029I]) through the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s National Center for Medical Rehabilitation Research, National Center for Complementary and Integrative Health, National Eye Institute, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, National Institute on Aging, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, NIH Blueprint for Neuroscience Research, and Office of Behavioral and Social Sciences Research; Department of Veterans Affairs (VA240-14-C-0057); Eli Lilly and Company; Foundation for Chiropractic Progress; Foundation for the National Institutes of Health; Gatsby Charitable Foundation; The Institute for Integrative Health; Janssen Research & Development, LLC; Jonas Nursing and Veterans Healthcare; Josiah Macy Jr. Foundation; Michigan Center for Interprofessional Education; The Kavli Foundation; Lundbeck Research USA; Merck Research Laboratories; The Michael J. Fox Foundation for Parkinson’s Research; National Academies of Practice; National Association of Social Workers; National Board for Certified Counselors and Affiliates; National Board of Medical Examiners; National Council of State Boards of Nursing; National League for Nursing; National Multiple Sclerosis Society; National Science Foundation (BCS-1064270); One Mind; Organization for Associate Degree Nursing; Physician Assistant Education Association; Sanofi; Society for Neuroscience; Society for Simulation in Healthcare; Takeda Pharmaceuticals International, Inc.; University of Toronto; Weill Cornell Medicine–Qatar; and Wellcome Trust. Any opinions, findings, conclusions, or recommendations
expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-49091-7
International Standard Book Number-10: 0-309-49091-X
Digital Object Identifier: https://doi.org/10.17226/25406
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Copyright 2019 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: 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: https://doi.org/10.17226/25406.
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PLANNING COMMITTEE ON THE ROLE OF NONPHARMACOLOGICAL APPROACHES TO PAIN MANAGEMENT1
DANIEL CHERKIN (Co-Chair), Kaiser Permanente Washington Health Research Institute (Emeritus)
ANTHONY DELITTO (Co-Chair), University of Pittsburgh
JOHN CHAE, Case Western Reserve University
MEGAN DRISCOLL, University of Pittsburgh Medical Center
KIM DUNLEAVY, University of Florida
STEVEN GEORGE, Duke University
ELIZABETH (LIZA) GOLDBLATT, Academic Collaborative for Integrative Health
ALAN JETTE, Massachusetts General Hospital Institute of Health Professions
ROBERT KERNS, Yale University
JOHN KRYSTAL, Yale University
ANNE MARIE MCKENZIE-BROWN, Emory University
VITALY NAPADOW, Massachusetts General Hospital; Harvard University
ROBERT SAPER, Boston University
DENNIS TURK, University of Washington
CHRISTIN VEASLEY, Chronic Pain Research Alliance
Health and Medicine Division Staff
SHEENA M. POSEY NORRIS, Program Officer
ANNA FAHLSTROM, Research Assistant
PHOENIX WILSON, Senior Program Assistant
CLARE STROUD, Director, Forum on Neuroscience and Nervous System Disorders
PATRICIA CUFF, Director, Global Forum on Innovation in Health Professional Education
ANDREW M. POPE, Director, Board on Health Sciences Policy
JULIE PAVLIN, Director, Board on Global Health
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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FORUM ON NEUROSCIENCE AND NERVOUS SYSTEM DISORDERS1
STORY LANDIS (Co-Chair), Director Emeritus, National Institute of Neurological Disorders and Stroke
JOHN KRYSTAL (Co-Chair), Yale University
SUSAN AMARA, Society for Neuroscience
RITA BALICE-GORDON, Sanofi
KATJA BROSE, Chan Zuckerberg Initiative
EMERY BROWN, Harvard Medical School and Massachusetts Institute of Technology
DANIEL BURCH, Pharmaceutical Product Development, LLC
JOSEPH BUXBAUM, Icahn School of Medicine at Mount Sinai
SARAH CADDICK, Gatsby Charitable Foundation
ROSA CANET-AVILES, Foundation for the National Institutes of Health
MARIA CARRILLO, Alzheimer’s Association
E. ANTONIO CHIOCCA, Harvard Medical School
TIMOTHY COETZEE, National Multiple Sclerosis Society
JONATHAN COHEN, Princeton University
ROBERT CONLEY, Eli Lilly and Company
JAMES DESHLER, National Science Foundation
BILLY DUNN, Food and Drug Administration
MICHAEL EGAN, Merck Research Laboratories
JOSHUA GORDON, National Institute of Mental Health
HENRY T. GREELY, Stanford University
RAQUEL GUR, University of Pennsylvania
MAGALI HAAS, Cohen Veterans Bioscience
RAMONA HICKS, One Mind
RICHARD HODES, National Institute on Aging
STUART HOFFMAN, Department of Veterans Affairs
STEVEN HYMAN, Broad Institute of Massachusetts Institute of Technology and Harvard University
FRANCES JENSEN, University of Pennsylvania
GEORGE KOOB, National Institute on Alcohol Abuse and Alcoholism
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
WALTER KOROSHETZ, National Institute of Neurological Disorders and Stroke
ALAN LESHNER, American Association for the Advancement of Science (Emeritus)
HUSSEINI MANJI, Janssen Research & Development, LLC
CAROLINE MONTOJO, The Kavli Foundation
ATUL PANDE, Tal Medical
STEVEN PAUL, Voyager Therapeutics, Inc.
EMILIANGELO RATTI, Takeda Pharmaceuticals International, Inc.
DOUGLAS SHEELEY, National Institute of Dental and Craniofacial Research
TODD SHERER, The Michael J. Fox Foundation for Parkinson’s Research
DAVID SHURTLEFF, National Center for Complementary and Integrative Health
PAUL SIEVING, National Eye Institute
NORA VOLKOW, National Institute on Drug Abuse
ANDREW WELCHMAN, Wellcome Trust
DOUG WILLIAMSON, Lundbeck
STEVIN ZORN, MindImmune Therapeutics, Inc.
Health and Medicine Division Staff
CLARE STROUD, Forum Director
SHEENA M. POSEY NORRIS, Program Officer
PHOENIX WILSON, Senior Program Assistant
BARDIA MASSOUDKHAN, Financial Associate
ANDREW M. POPE, Director, Board on Health Sciences Policy
GLOBAL FORUM ON INNOVATION IN HEALTH PROFESSIONAL EDUCATION1
CASWELL EVANS (Co-Chair), University of Illinois at Chicago College of Dentistry
DEBORAH POWELL (Co-Chair), University of Minnesota
MALCOLM COX (Co-Chair Emeritus), University of Pennsylvania, formerly Department of Veterans Affairs
SUSAN SCRIMSHAW (Co-Chair Emeritus), The Sage Colleges
FRANK ASCIONE, University of Michigan
TIMI AGAR BARWICK, Physician Assistant Education Association
DAVID BENTON, National Council of State Boards of Nursing
JOANNA CAIN, University of Massachusetts School of Medicine
KATHY CHAPPELL, American Nurses Credentialing Center
STEVEN CHESBRO, American Physical Therapy Association
AMY APARICIO CLARK, Aetna Foundation
DARLA SPENCE COFFEY, Council on Social Work Education
DARLENE CURLEY, Jonas Nursing and Veterans Healthcare
JAN DE MAESENEER, Ghent University
MARIETJIE DE VILLIERS, Stellenbosch University
KIM DUNLEAVY, American Council of Academic Physical Therapy
KATHRIN (KATIE) ELIOT, Academy of Nutrition and Dietetics
ELIZABETH (LIZA) GOLDBLATT, Academic Collaborative for Integrative Health
CATHERINE GRUS, American Psychological Association
SUSAN HANRAHAN, Association of Schools of the Allied Health Professions
NEIL HARVISON, American Occupational Therapy Association
ERIC HOLMBOE, Accreditation Council for Graduate Medical Education
ELIZABETH HOPPE, Association of Schools and Colleges of Optometry
HOLLY HUMPHREY, Josiah Macy Jr. Foundation
EMILIA IWU, Jonas Nursing and Veterans Healthcare
PAMELA JEFFRIES, The George Washington University
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
SANDEEP (SUNNY) KISHORE, Young Professionals Chronic Disease Network
KATHLEEN KLINK, Veterans Health Administration
CHAO MA, Peking Union Medical College
ANDREW MACCABE, Association of American Veterinary Medical Colleges
LAURA MAGAÑA VALLADARES, Association of Schools and Programs of Public Health
LUCINDA MAINE, American Association of Colleges of Pharmacy
BEVERLY MALONE, National League for Nursing
MARY E. (BETH) MANCINI, Society for Simulation in Healthcare
ANGELO MCCLAIN, National Association of Social Workers
LEMMIETTA G. MCNEILLY, American Speech-Language-Hearing Association
MARK MERRICK, Commission on Accreditation of Athletic Training Education
DONNA MEYER, Organization of Associate Degree Nursing
WARREN NEWTON, American Board of Family Medicine
BJÖRG PALSDOTTIR, Training for Health Equity Network (THEnet)
MIGUEL PANIAGUA, National Board of Medical Examiners
RAJATA RAJATANAVIN, Mahidol University
LUCY SAVITZ, Kaiser Permanente
WENDI SCHWEIGER, National Board for Certified Counselors, Inc. & Affiliates
NELSON SEWANKAMBO, Makerere University College of Health Sciences
STEPHEN SHANNON, American Association of Colleges of Osteopathic Medicine
JAVAID I. SHEIKH, Weill Cornell Medicine–Qatar
SUSAN SKOCHELAK, American Medical Association
ZOHRAY TALIB, The George Washington University
MARIA TASSONE, University of Toronto
DEBORAH TRAUTMAN, American Association of Colleges of Nursing
MICHELLE TROSETH, National Academies of Practice
RICHARD (RICK) W. VALACHOVIC, American Dental Education Association
CYNTHIA A. WALKER, Medtronic
ALISON J. WHELAN, Association of American Medical Colleges
ADRIENNE WHITE-FAINES, American Osteopathic Association
XUEJUN ZENG, Peking Union Medical College
BRENDA ZIERLER, University of Washington
Health and Medicine Division Staff
PATRICIA A. CUFF, Senior Program Officer
ANNA FAHLSTROM, Research Assistant
DANIEL CESNALIS, Financial Associate
JULIE PAVLIN, Director, Board on Global Health
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
ROGER CHOU, Oregon Health & Science University
PENNEY COWAN, American Chronic Pain Association
CARMEN GREEN, University of Michigan Medical School
CATHERINE LIVINGSTON, Oregon Health Authority
ERIC SCHOOMAKER, Uniformed Services University of the Health Sciences
HEATHER TICK, University of Washington School of Medicine
BOB TWILLMAN, Academy of Integrative Pain Management
JUDY WATT-WATSON, University of Toronto
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BRIAN STROM, Rutgers, the State University of New Jersey. He was responsible for making certain that an independent examination of this proceedings was carried out in
accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
Contents
Organization of the Proceedings
2 WORKSHOP CONTEXT: LIVED EXPERIENCE, PROVIDER PERSPECTIVES, AND CURRENT PATTERNS OF USAGE
Lived Experience and Provider Perspectives
Background on Pain and Nonpharmacological Pain Management
Examining the Effectiveness and Safety of Nonpharmacological Approaches
Cost-Effectiveness and Cost Savings from a Societal Perspective
Potential Research Priorities Moving Forward
Stepped Care, Stratified Care, and Matched Care
Care for Patients with Complex and High-Impact Chronic Pain
Using Technology to Support Access, Self-Management, and Care Processes
5 MAJOR CURRENT RESEARCH INITIATIVES AND PRIORITIES
Patient-Centered Outcomes Research Institute
Department of Veterans Affairs
6 EDUCATION AND TRAINING OF HEALTH PROFESSIONALS IN PAIN MANAGEMENT
Interprofessional Education Models
Collaborative Practice: A Team-Based Approach for Pain Management
The Payer Perspective: Insurance Coverage and Reimbursement
