AAPM submits comments to CDC on management for acute, chronic pain

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Ensuring physician autonomy and pain management solutions catered to the patient are two of the key messages the American Academy of Pain Medicine put to the Centers for Disease Control and Prevention Tuesday.

After an April 19 call for comments on the management of acute and chronic pain by the CDC, the AAPM submitted its public comments online.

Among them were a desire for the process of prescribing pain management treatments to be left to the patient and the physician.

“Acknowledge and emphasize the importance of individualized patient care,” the comments said. “Preservation of physician autonomy in clinical decision-making is paramount to the delivery of patient-centered care.”

The AAPM also highlighted the importance of reducing regulatory barriers for physicians surrounding opioid prescribing, while promoting safe prescribing practices, evidence-based guidelines and strategies, and patient education regarding the risks and side effects of opioids, including withdrawal, dependency, and addiction. The AAPM called for regular opioid use screenings and monitoring, measuring functional outcomes and

Further, the AAPM submitted that the decision to taper opioids should remain between the patients and the physician, noting that while there are tapering guidelines, there is also a heightened risk of death from overdose or suicide after stopping opioid treatment and that there are potential harms from forced opioid tapering.

One barrier to reducing opioid use in pain management the association said, was the barrier physician’s had in prescribing non-pharmacological strategies, like acupuncture, chiropractor, nutrition consultations, exercise programs, physical therapy, mental health support or integrative medicine. Lack of insurance coverage, or insufficient insurance reimbursement for those strategies, as well as inadequate access to non-pharmacological strategies, were one of many barriers physicians faced in prescribing non-opioid therapies. Addressing compassionate, effective pain care would decrease wide-spread suffering, the association said, but required additional solutions to ‘insurance-based barriers to evidence-based non-pharmacological pain management interventions.”

Lastly, the association said care should be given to monitor for and treat substance use disorder while managing pain. By normalizing substance use disorder as a treatable disease and reducing the stigma of substance use disorder treatment, the country can address opioid addiction. Still, the association said it was important to allow physicians to individualize treatment plans to the patients in their care.

And, the association stressed, it was important to ensure that those on opioids had access to mental health and behavioral health care.

The CDC had posted on the Federal Register a request for stakeholders in chronic and acute pain – including patients, caregivers, and health providers with “perspectives on and experiences with pain and pain management, including but not limited to the benefits and harms of opioid use.”

The comments were unusual in that they asked for patient and caregiver experience. The CDC said the comments would help expand their understanding of opioid use.

“Public comment will help CDC’s understanding of stakeholders’ values and preferences regarding pain management and will complement CDC’s ongoing work assessing the need for updating or expanding the CDC Guideline for Prescribing Opioids for Chronic Pain,” the agency said.

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