The problem with Opioids is a failure to manage pain. While pain management is a priority in hospitals and part of hospital and physician culture, the problem with management has a lot to do with the diagnosis and where that diagnosis leads.
The truth is that non medical providers are better trained at evaluating and treating chronic pain. Consumer Reports often cites chiropractic management as having some of the highest levels of satisfaction from patients, yet insurers continue to pay more for drugs and interventions, while under funding these more effective sources.
After 30 years in the business, as a healthcare provider, I can safely state that it all comes down to the history and the exam. Medical tests all too often are done in place of this and management is often based on the wrong objective findings such as a positive MRI, a painful orthopedic test, while ignoring the mechanism of pain which commonly is different from the pain itself. A good example of this is back pain, which is often called a disease, yet it is a mechanical malfunction that can be caused by the pelvis, the hips, the feet and even the upper body, yet care is often directed toward the lower back, on a diagnostic tract that ignores that different people have different mechanisms of movement and pain which need to be understood. Diagnostic tracts are supposed to be a guideline of how to proceed, yet it is often how most practitioners treat instead, and after throwing therapy after therapy does not work, the tract tells us to test with an MRI, or refer to a more aggressive approach which may result in a poor outcome, because the cause have never been fully understood. On the other hand, a good physical evaluation and history using the current ideas of active evaluation may give us a more individualized understanding of why the person hurts and lead to a better and more consistent outcome.
Problems in the back may affect the way we walk, move and feel and can cause symptoms such as plantar fasciitis, neck pain, headaches, shoulder pain as well as knee pain and meniscus tears. Often doctors would recommend a opioid which if used for a short period of time could result in an unexpected dependency.
Should insurers encourage the use of drug free providers; absolutely. They should also consider paying primary care better so they have the time to do more thorough evaluations, something many of them cannot afford to do with the current levels of reimbursement which results in the wrong types of referrals to providers who run up costs in the system with tests that cost much more than paying providers more for their time.
You can read more about this article in the Huffington Post here
AMA, Other Leading Medical Organizations Urge Insurance for Non-Pharma/Integrative Pain Care
12/17/2016 John Weeks
Publisher and Editor, Integrator Blog News & Reports
The nation”™s crisis in pain treatment and need to reduce opioid dependence has lifted a powerful chorus of voices to change insurance practices. The American Medical Association is among the organizations urging payers to cover non-pharmacological approaches. Many specifically extend this call to integrative treatments.
The statements were discovered by representatives of the Acupuncture Now Foundation (ANF) and the American Society of Acupuncturists (ASA) among comments submitted to the USA Center for Disease Control and Prevention (CDC). CDC had a public comment period prior to its March 2016 issuance of its Guidelines for Prescribing Opioids for Chronic Pain.
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Stated Mathew Bauer, LAc, ANF president: “œMainstream group after mainstream group [is] telling the CDC that physicians can”™t act on the CDC”™s number one recommendation regarding how to avoid relying on opioids because of a lack of insurance coverage for CAM/integrative therapies. I have never seen anything like this.”
Among those echoing the AMA in calling for this reform of insurance practices are the American Society of Anesthesiologists (ASA), American Pain Society (APS), Medical Board of California (MBC), American College of Physicians (ACP), American Academy of Pain Management (AAPM, now AIPM), and Trust for America”™s Health (TFAH). The comments are detailed in a recent editorial published online in the Journal of Alternative and Complementary Medicine (JACM). Some sample comments provided by ANF/ASA to the journal are as follows:
“œNon-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain. Providers should only consider using opioid therapy if expected benefits for pain and/or function are anticipated to outweigh risks. In order to achieve this goal, public and private payer policies must be fundamentally altered and aligned to support payment for non-pharmacologic treatments and multimodal care.” (AMA)
“œMany insurers don”™t adequately cover or reimburse for non-pharmacologic therapies such as acupuncture, biofeedback, relaxation, and other interactive, multimodal therapies. Payer policies””both public and private””would need to be fundamentally changed to support this recommendation.” (TFAH)
“œWe believe that patients should have both pharmacological and non-pharmacological approaches available and reimbursed … for the management of their chronic pain.” (APS)
“œAt a bare minimum, recommendations that payers provide universal coverage for the five types of nonpharmacologic care mentioned in the [Department of Defense/Veteran”™s Administration] pain guideline (physical manipulation, massage, acupuncture, biofeedback, and yoga) should be issued.” (AAPM)
“œWhile it is true that many non-pharmacologic modalities are effective for the treatment/control of chronic pain, the [draft] Guidelines fail to address the fact that many patients do not have access to these modalities, due to lack of insurance coverage or low availability.(MBC)