NEW YORK (Reuters Health)—People with persistent pain need better access to psychosocial care, according to a position statement from the Society of Behavioral Medicine (SBM).
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“Psychosocial approaches to pain management need to be available for all individuals with persistent pain in all healthcare settings,” Dr. E. Amy Janke from the University of the Sciences, in Philadelphia, told Reuters Health by email.
The U.S. government’s 2016 National Pain Strategy stresses the importance of comprehensive, interdisciplinary pain care. But despite convincing evidence supporting the efficacy of psychosocial approaches, these interventions are inaccessible to most Americans with persistent pain, Dr. Janke and colleagues on the SBM Health Policy Committee note.
The authors offer 10 policy recommendations for improving access to psychosocial care in a report online January 27 in Translational Behavioral Medicine.
Healthcare systems should support access to psychosocial pain care, remove system-related barriers that impede effective psychosocial care provision, ensure that providers who have competence in psychosocial pain care are available in settings where patients with persistent pain are regularly managed, and provide tools that support referral to psychosocial pain-care specialists.
For their part, healthcare payers should reimburse evidence-based psychosocial approaches in the care of persistent pain and reimburse according to a disease-management rather than fee-for-service approach, the authors say.
They also note that professional, education and training organizations should play their part by prioritizing training of pain providers, participating in the interprofessional education of healthcare providers in psychosocial pain care, integrating pain education at all levels of training and formally recognizing “pain psychology” as a specialty.
The committee also recommends that researchers “examine implementation models of psychosocial pain care across healthcare settings to determine best practices and improve dissemination of evidence-based model delivery systems.”
“While there’s overall agreement about the benefits of an interdisciplinary approach to pain care as outlined in the National Pain Strategy and the importance of psychosocial pain care generally, reimbursement structures and hospital systems aren’t designed to support such care,” Dr. Janke said. “Physicians don’t feel they have the time or training to provide the kind of care patients with pain need.”
“So, the controversy is that the disconnect between policy and guideline recommendations doesn’t allow providers to offer optimal care – guidelines underscore one thing, policy supports another, and physicians and patients are caught in the middle,” she said.
“The pain and opioid crises are related, and multiple points of system failure contribute to both,” Dr. Janke said. “The result is needless suffering. Feasibility of evidence-based recommendations to improve patient care and patient outcomes will be limited until policies are in place that actually promote this care.”
Dr. Heather K. Vincent, director of the University of Florida’s Human Performance Laboratory in Gainesville, Florida, told Reuters Health by email, “Helping patients cope with pain requires unique skills. The inclusion of a pain psychologist can help patients in ways that are sometimes not measurable in metrics that medicine publishes. A course of life can be changed with the simple act of having a psychologist talk to the patient and show that someone cares about them – and takes the time to see what they need.”
“The driving force for most practitioners embracing the use of psychosocial support for their patients is reimbursement,” said Dr. Vincent, who was not involved in the new statement. “If given the choice to provide services, physicians are more likely to choose the services that reimburse rather than those that do not.”
“Physicians know and generally believe in the importance of psychosocial support but do not have a sustainable mechanism to provide it,” Dr. Vincent said. “This is frustrating for physicians because metrics of performance are typically based on RVUs (relative value units) rather than patient-focused plans which could and should include psychosocial support. I feel that this is the key domino to start the dominos falling into place: to getting these services as part of mainstream medicine.”
Dr. Sean O’Mahony, director of palliative medicine at Rush University Medical Center, in Chicago, who also was not part of the committee, told Reuters Health by email, “Medical providers receive scant training on the effectiveness of psychological modalities for pain. Without knowledge they are unlikely to refer for evidence-based modalities and patients are unlikely to be aware of the effectiveness of these modalities.”
“In spite of the political rhetoric and policy statements on the importance of educating medical providers on pain management, when we surveyed medical house staff at our institution we found that 80% of incoming medical house staff had not had formal education on safe management of pain,” he said. “As a result, we created a dedicated 1-week rotation for all medical interns which includes content on the role of psychosocial assessments and interventions for patients with chronic pain.”
Another constraint, he said, is that “insurance companies will often limit access to mental health providers or require large co-pays but pay for prescription medications.”
“Physicians should familiarize themselves with evidence-based non-medication approaches, including psychological modalities, and find ways to integrate them into the care of patients with acute and chronic pain,” Dr. O’Mahony concluded.
Transl Behav Med 2018.