Plenary Lecture: Integrated Approach to Chronic Pain
Friday, July 28
Opioid addiction is a growing epidemic in the United States, and proposals to contain the problem have not gained traction. However, a group of health-care providers is working to reverse that trend by training providers to advocate for patients. The goal is to persuade insurers to approve coverage of pain management alternatives beyond opioids.
“Payers should embrace the comprehensive plan of care for chronic pain and reimburse the various elements that health-care providers might use to help someone manage chronic pain,” said P. David Charles, MD, who will present “Integrated Approach to Chronic Pain.”
“For methods of pain management other than opioids, many times there is pushback where those elements that take a comprehensive approach to pain are not covered,” said Dr. Charles, chief medical officer of the Vanderbilt Neuroscience Institute and director of telemedicine at Vanderbilt University Medical Center. “Sometimes the providers’ hands are tied because there are few options they can choose for patients with chronic pain.”
The alternatives to opioids include physical therapy, exercise, injection of medications in areas of chronic pain, and psychological therapies, said Dr. Charles, a chairman of the Alliance for Patient Access, which has a Pain Therapy Access working group.
Insurance companies will often approve alternative therapies for only a limited amount of time, which does not help patients with chronic pain, he said.
“Then what? The physician is morally obligated,” Dr. Charles said. “You can’t have a legitimate patient in front of you say they are in legitimate pain and just ignore them. Sometimes an insurance plan may not approve something like massage therapy, but you can write prescriptions with little resistance.”
Health-care providers can help patients appeal to their insurance companies for more non-opioid coverage, but that change only applies to that individual patient and does not address the larger problem of a lack of coverage alternatives.
The Alliance for Patient Access regularly presents training sessions for groups of 12 to 20 providers to learn how to better advocate for patient access to additional therapies.
“What our group does is train providers in techniques to advocate at the policy level for an insurance company to improve its coverage for all patients covered in the plan,” Dr. Charles said. “If you want more access to physical therapy, then instead of appealing on behalf of an individual patient, let’s go directly to the insurer and to the medical director. Learn to understand the policy, present the evidence of why the policy needs to be improved, and work with them to accomplish that goal.”
The key to expanding treatment options covered by insurance is for more health-care providers to join professional groups that will advocate for change with insurers, as well as legislators.
“Be involved in the health-care policy debate. Too often, we feel the system is too big, and there is nothing we can do as individual providers, but we can have an impact on health-care policy if we engage,” Dr. Charles said. “Patients need to have better access to the full range of options that can be used to treat chronic pain.”