The Role of Nonpharmacological Approaches to Pain Management Proceedings of a Workshop (2019) / Chapter Skim
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2 Workshop Context: Lived Experience, Provider Perspectives, and Current Patterns of Usage
2 Workshop Context: Lived Experience, Provider Perspectives, and Current Patterns of Usage
Pages 5-14
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From page 5... ...
. • Placebo responses and interindividual variability in pain thresh olds and response to treatment may confound evaluations of the effectiveness of pain treatments (Kroenke, Turk)
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From page 6... ...
One reason for the low level of evidence available for nonpharmacological approaches to pain management is the variability in frequency, duration, and type among studies, said Veasley. Another problem is that in order to systematically and quantitatively review data from studies, outcomes must be assessed in a comparable manner, which is complicated by the fact that chronic pain may vary substantially from day to day and week to week and by limitations of the scales used for assessing pain.
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From page 7... ...
Now in his current position in Richmond, Virginia, he faces different challenges -- for example, 40 percent of new adult patients in his practice lack insurance, are covered by the system's indigent care plan, and have limited access to nonpharmacological therapies. Although he can make referrals for physical therapy or other services, patients face practical barriers that limit access to those services, such as transportation challenges and concerns about taking time off work to go to appointments on a consistent basis.
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From page 8... ...
He also advocated for efforts to improve provider–patient communication regarding treatments and goals for managing chronic pain using collaborative and holistic approaches that encourage shared decision making. Veasley added that a paradigm shift is needed wherein all relevant stakeholders come together at the genesis of a research project and work collaboratively throughout it to bridge the translational divide between basic science and patient care.
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From page 9... ...
It was no surprise, George added, that when the Institute of Medicine published its report Relieving Pain in America they concluded that pain is a major driver of health care, disability, and reduced quality of life (IOM, 2011b)
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From page 10... ...
Typically, a patient's first contact with a health care provider trained in conventional medicine leads to diagnosis and drug treatment, with management of pain through nonpharmacological and other approaches only introduced later. Recent changes in the guidelines for how pain is managed aim to shorten that interlude, moving nonpharmacological care closer to the first contact point through more cohesive and integrated management pathways, said George.
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From page 11... ...
Other important factors contributing to the modest effectiveness of pain treatments is interindividual variability in pain thresholds, response to various treatments, and psychosocial characteristics that influence the experience of pain and the response to treatments, said Turk. Patients also vary in terms of the relationship between objective evidence of pathology and how intensely they experience pain (e.g., patients with the same extent of tissue pathology respond in widely different ways to the same interventions)
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From page 12... ...
He noted that Medicare and Medicaid populations encounter increased coverage constraints because most states provide limited to no coverage for acupuncture and chiropractic care. Using a technique that takes claims data and creates "episodes of care" as a means of understanding spending by diagnostic condition, Elton showed that musculoskeletal complaints are responsible for about 16 percent of costs as well as most prescriptions for opioids and opioid-containing medicines, with back pain being the most frequent complaint.
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From page 13... ...
In a randomized clinical trial of this literacyadapted and simplified group CBT approach compared with group pain education or usual care, they showed that after treatment, participants in the modified CBT and group pain education arms had lower pain intensity scores and improved function compared with the usual care arm (Thorn et al., 2018)
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From page 14... ...
14 NONPHARMACOLOGICAL APPROACHES TO PAIN MANAGEMENT ical approaches such as exercise and yoga are also needed for certain subpopulations (e.g., older adults) who may have limited mobility, flexibility, strength, or stamina.
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