Federal Task Force Issues Best Guidance Ever on Pain Management

Your patient cries out, “Doc, I’m in pain.”

The government steps in and tells you to follow its 948-word pain management guideline. That’s the short version, from the executive summary. The full set of recommendations is 112 pages.

This final set of guidelines, “Pain Management Best Practices Interagency Task Force Draft Final Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations,” was written by a 29-member Pain Management Best Practices Inter-Agency Task Force, set up under the federal Comprehensive Addiction and Recovery Act (CARA) of 2016.

It was scheduled to have been approved late in the day May 9 at a task force meeting. The task force’s mini-website at the Department of Health and Human Services (HHS) website hosting the task force didn’t post a confirmation, but the approval seems to have been a pro forma action at that stage. (We asked HHS for confirmation but didn’t hold up this story to wait for it.

As we reported on an earlier draft (Orthopedics this Week, January 8), the task force criticized the 2016 Centers for Disease Control (CDC) opioid prescribing guidelines as being too simplistic and one-size-fits-all, noting that the CDC guidelines were widely taken as de facto rules, and likely drove some patients to illegal opioids or even suicide. (https://ryortho.com/breaking/draft-federal-report-slams-cdc-opioid-policies/

These final guidelines go all the way in another direction; the recommendations are so deep and detailed that if their 112 pages can be faulted for anything, it’s that they turn the task of pain mitigation into a lengthy series of committee meetings and processes for caregiver organizations to consider alternatives to opioids rather than simply prescribing them.

But that may be what’s needed. The task force guidelines “balance the need to effectively manage patients’ pain while also advancing policies to end the epidemic of opioid-related deaths,” said the American Medical Association (AMA) in a news release supporting them.

“These recommendations are a lifeline to pain patients who have been caught in the middle of policy efforts that have produced harmful unintended consequences,” said AMA President-Elect Patrice A. Harris, M.D., chair of the AMA Opioid Task Force. “This is a road map to help physicians and policy makers take sustainable steps to end the epidemic and improve pain care.”

The AMA has its own task force, which focused on these best practices for physicians prescribing opioids, including:

• Use your state prescription drug monitoring program (PDMP);
• Be sure that you have the education and training to prescribe effective, evidence-based treatment;
• Support and advocate for comprehensive care for patients in pain and those with a substance abuse disorder;
• Removing stigma is essential to ending the nation’s opioid epidemic;
• Expand access to naloxone in the community and through co-prescribing; and
• Work with your patients to promote safe storage and disposal of opioids.

The AMA opioids website promotes a continuing education module, “A Primer on the Opioid Morbidity and Mortality Crisis: What Every Prescriber Should Know.” Unlike many CME modules of the AMA and others, this one is free. As of when we checked, 1,325 physicians had signed up.