Pauline Anderson

October 24, 2017

SAN DIEGO — Clinicians, health insurers, and other stakeholders have initiated meetings that many pain experts hope will result in extending insurance coverage to include yoga, acupuncture, and other integrated approaches to pain management.

The first-ever Integrative Pain Care Policy Congress was launched here at the Academy of Integrative Pain Management (AIPM) 28th Annual Meeting

More than 50 delegates, including representatives from professional associations, public and private insurers, patient advocacy groups, and others, are meeting behind closed doors to discuss the possibility of extending coverage to complementary and alternative medicine (CAM) approaches to pain management.

Many experts believe such a move would improve the lives of millions of Americans who suffer from chronic pain while saving billions of healthcare dollars and reducing opioid prescribing.

The Congress is timely, AIPM President W. Clay Jackson, MD, clinical assistant professor of family medicine and psychiatry, University of Tennessee College of Medicine, Memphis, told Medscape Medical News.

Dr W. Clay Jackson

"We have a dual health crisis in this country. We have a crisis of overprescription of opioids but undertreatment of chronic pain."

Right now, many pain patients can't afford the very treatments that might offer them the most benefit.

Dr Jackson used the example of a patient who needs pay only a $4 to $5 copayment for a generic opioid prescription but must spend $70 for a single session of acupuncture.

"That's a 17-fold increase in their out-of-pocket expense for a treatment which, for that individual patient, may be helpful and cause minimum harm."

The Art of Medicine

While in an ideal world all helpful pain management approaches would be covered by insurance, Dr Jackson anticipates that payers will require some level of evidence that these techniques are cost-effective.

There's "a great deal" of evidence supporting various integrative pain management approaches — and that evidence is growing, said Dr Jackson, However, it doesn't always meet the gold standard the Food and Drug Administration requires to approve drugs: two positive randomized controlled clinical trials.

The question is, said Dr Jackson, where should "the bar" be for evidence supporting integrated pain management? He stressed the difference between "evidence-based" and "evidence-guided" care.

"Very little of what we do in medicine is actually evidence-based. A great deal of what we do is accepted clinical practice, what clinicians feel is working for patients."

It's important to determine "how to collate" evidence supporting integrated pain management approaches into "a digestible form" for decision-makers, such as "large payer organizations," said Dr Jackson.

Dr Jackson said he hopes Integrative Pain Care Policy Congress will yield a "consensus" on the level of evidence needed for CAM approaches to be insured.

He also hopes the discussions will help overcome the "stigmatization" of patients with chronic pain.

"These patients are not necessarily looking for opioid treatment, or even pharmacological treatment.  They just want relief from their pain."

Finding Middle Ground

Robert Alan Bonakdar, MD, past president of the AIPM and director of pain management at the Scripps Center for Integrative Medicine, La Jolla, California, agreed that there's a "big disconnect" between treatments patients find effective and those that are covered by insurance.

The goal of the Congress is for decision-makers, policymakers, legislators, and pain experts to "come to a middle ground" in this area, Dr Bonakdar told Medscape Medical News

"We can't continue with this disconnect because, at the end of the day. it leaves pain patients at the door — without effective treatments that they can access. The whole thing is about access."

Currently, the decision-making process for coverage is "outdated" and needs to be more "progressive" and "patient-centric," added Dr Bonakdar.

He said he expects that some "action items" will come out of Congress meetings, perhaps a committee being formed that will take the initial ideas and "move them forward."

In addition to achieving a consensus on the definition of comprehensive, integrative pain care, the Congress discussions will aim to explore payment models "that take into account the intersections between pain management, addiction, and behavioral health," said a press release announcing the Congress.

The goal is to develop a meaningful action plan, with consensus policy and advocacy goals for 2018, said the release.  

The AIPM will update members on the outcomes of the talks as early as this week, Amy Goldstein, director, State Pain Policy Advocacy Network, AIPM, told Medscape Medical News.

Dr Jackson and Dr Bonakdar have disclosed no relevant financial relationships.

Academy of Integrative Pain Management (AIPM) 28th Annual Meeting.

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