By Cindy Perlin, Guest Columnist
Many chronic pain patients who have depended on opioids to manage their pain have posted comments critical of the CDC's draft guidelines and rightfully so. No patient who is in severe chronic pain should be required to reduce their pain medication unless and until they have been provided with access to treatment that is at least as effective as their current opioid regimen.
Efforts to reduce use of opioids have driven legitimate pain patients to use of heroin and have not stemmed the opioid abuse epidemic. In fact, addiction and overdoses have only increased.
Preventing addiction is the key to saving lives. The best way to do this is to reduce the number of new prescriptions for opioids unnecessarily dispensed to pain patients. Fortunately, curtailing opioid prescriptions can be done without harm to pain patients because safer, more effective treatments exist.
However, significant barriers to access to alternative pain treatments exist. Financial obstacles because of lack of insurance coverage, inadequate availability of services, and lack of knowledge of alternatives by both patients and their physicians prevent patients from receiving the most appropriate care.
A significant factor that has led to inadequate availability of many pain treatments is the fact that non-physician in-network providers who are reimbursed by health insurers have not, for the most part, received any fee increases in over 35 years; whereas physicians have received numerous increases. These providers include chiropractors, physical therapists, occupational therapists, and mental health practitioners.
Availability of these services has decreased as more providers are leavingand fewer providers are entering these disciplines, because of a 65% decline in real wages owing to inflation.
To reduce these impediments to effective pain treatment, I propose a Pain Treatment Parity Act (PTPA), which would require all entities that pay for treatment of chronic pain -- including public and private insurers -- to cover all pain treatments that have credible evidence of effectiveness to the same degree that they cover pharmaceutical treatment of pain.
This includes both qualitative and quantitative limitations on care, such as equivalence in pre-treatment authorization requirements, limits on number of visits or dosage restrictions, copayment requirements, as well as equivalent fee schedules.
Provisions of the PTPA
1. All pain treatments with some credible evidence of effectiveness must be covered when provided by a licensed or certified provider. This includes any treatments with at least one well-designed randomized, controlled trial showing a significant benefit from the therapy and a good safety profile or any other reasonable evidence of safety and effectiveness.
Therapies that currently meet this standard include chiropractic, physical and occupational therapy, acupuncture, biofeedback, massage therapy, homeopathy, nutritional counseling and supplements, herbal therapy, psychotherapy, energy medicine therapy, supervised exercise programs, and multidisciplinary interventions, including coordination of services.
2. There can be no restrictions on the number of treatment visits or length of treatment for nonpharmaceutical pain treatment, unless there are similar restrictions on dosage or length of treatment for the preponderance of pharmaceutical treatments for pain.
3. Copays for visits to nonphysician pain treatment providers cannot exceed the copayment for primary care physician visits.
4. There cannot be a separate deductible for nonphysician pain treatment providers.
5. Preauthorization for visits to nonphysician pain treatment providers cannot be required unless preauthorization is required for pharmaceutical treatments for pain.
6. Medical necessity reviews cannot occur with greater frequency for nonphysician pain treatment providers than for physicians who provide pharmaceutical treatment for pain.
7. Fee schedules for in-network chiropractors, physical therapists, occupational therapists, psychologists, social workers, mental health counselors, acupuncturists, massage therapists, and all other nonphysician pain treatment providers must be increased by the same percentage as the average increase in fees for physicians for all specialties since 1980.
8. If an insurance plan has out-of-network benefits for medical and surgical treatments, it must also cover nonphysician out-of-network pain care providers at the same level of reimbursement.
9. All medical schools must offer a required course in pain management that covers all currently available treatments and the evidence supporting their use.
10. All physicians who treat chronic pain patients who have not completed a course in pain management in medical school must complete a 12-hour CME course about the safety and efficacy of all currently available treatments for chronic pain.
The Centers for Disease Control And Prevention (CDC) should champion this or similar legislation along with its opioid prescribing guidelines.
Cindy Perlin is a Licensed Clinical Social Worker, certified biofeedback practitioner, chronic pain survivor and the author of “The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free.”
For the last 25 years Cindy has helped her clients improve their emotional and physical well-being through her private practice near Albany, New York.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.