| One-Minute Clinician

Putting the Patient First When Making Policy

A lot of bills are being introduced to combat the opioid crisis. But rather than just focusing on opioids or taking opioids away, we need comprehensive solutions to help manage pain long term. Medicare made several changes in terms of how opioids are prescribed, namely certain hard stops for opioid prescribing. I think that’s going to have implications for patients with chronic pain, whether they’re already taking higher doses or going to need escalating doses. One of the challenges is that policies are preceding evidence based medicine. Hopefully, we’re not creating any kind of unneeded disparities in terms of access to those medications or variations in care because of the awareness of these hard stops. The goal is always to focus on interdisciplinary care and the biopsychosocial model of pain. Not every clinician is going to have access to resources like we have in a tertiary pain management center, but what about other resources? Maybe apps or widely circulated free resources or different creative ways of incorporating that biopsychosocial model of pain. That’s a goal because we know that people who need to come to a pain clinic may have barriers to get there. If we can spread the word about the basics of pain management, we can help our frontline practitioners. With the current healthcare climate, I’m worried that practitioners are going to be pigeonholed by policies, and what we really want is always to be thinking “What is best for our patients?” I don’t want any practitioners to be scared of treating chronic pain or prescribing certain drugs because of what is happening in terms of legislation. Then the conversation gets focused on one piece and the rest gets lost. I want to make sure that for every patient, regardless of their insurance status, regardless of whether they live in a rural or urban area, there is some sort of uniform level of pain treatment across the nation. I know that we have a long way to go, and there are so few pain specialists. I’d love to see pain education become more mainstream for medical schools so that people are getting more than just pharmacology upfront. I’d like to see this biopsychosocial model incorporated into the curriculum of medical schools, but it will take some time. Or perhaps there will be a newer subspecialty. We need to take a step back and make sure we are treating the whole patient, that our research is focusing on new therapies and new developments in the arena of pain management.