This week I have two articles to share with you about chronic pain and the many types and treatments. The first article is about the different types of pain and how defining them can help find better treatments. The second article is about Medicare now offering to cover acupuncture for chronic lower back pain. Below are these articles and my thoughts on their implications.
Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.
Millions of people across the globe suffer from chronic pain every day. However, there is much more to be discovered when it comes to adequate ways to treat this pain and it starts with understanding the different types. Pain falls into three categories – nociceptive (direct damage to tissue), neuropathic (damage to pain-sensing nerves) and nociplastic (no obvious injury). The third category is relatively new (accepted in November 2017 by the International Association for the Study of Pain) and lends credence to those with it that have often been misunderstood. The individual who wrote this article took part in a pain study at the University of Michigan to help scientists and doctors find better forms of treatment for those specific types of chronic pain.
The diversity of pain should not be unexpected, nor the need to find specialized (individualized) treatment. But this interesting article presented the more detailed search for causes of pain and the “precision medicine movement” in developing a treatment plan. One thing new for me was a third category of pain (added to nociceptive and neuropathic)—nociplastic (“characterized by the absence of any nerve or tissue damage in the parts that hurt”, “central sensitization”). This new mechanism of pain is how fibromyalgia can be categorized. Check out the “How to match a person’s pain to their treatment: a clinical strategy” graphic near the end. And the discussion of the “default mode network…salience network…insula” in the brain. And the discussion about CBT. Here is the bottom line: “All this pain classifying is more than an academic exercise: It should help guide how to treat people.” Every person’s pain—physical, psychological, emotional, relational, financial, fill in the blank—is unique to them. There are so many subjective and objective variables before the onset of pain, during the pain, and future aspirations that makes the possibilities incalculable. While many people can be sympathetic (“I’m so sorry for your loss”), and some can even be empathetic (“My father passed away suddenly too”), nobody can truly understand what an individual is going through. Add to that the concept of “we can’t figure out what’s causing your pain” (nociplastic) and you’ve got a real problem. All of which means creating a customized treatment plan for that individual with that condition at this time (that adjusts over time) is the only way to provide true relief. And that can only come about when you start with a large list of evidence-based treatment options from which to choose.
In an effort to reduce opioid prescriptions to treat pain and reduce substance use disorder, Medicare will now cover acupuncture therapy to treat chronic lower back pain. There is still debate whether acupuncture is effective. However it is a low-risk treatment option that could potentially help many seniors.
If Medicare is paying for acupuncture (for “non-specific lower back pain that lasts 12 weeks or more”), shouldn’t Workers Comp? Up to 12 visits over 90 days is covered to treat chronic low back pain, with an additional eight visits available if there is demonstrated improvement (up to a total of 20 treatments in one year). That is counterbalanced by the requirement for improvement (a reasonable expectation – if it’s not helping the patient then move onto something else). Beyond authorizing it as treatment, another possible direct impact to Work Comp is the Medicare Set-Aside (MSA) per this interesting article from Jean Goldstein. As she said, “acupuncture is relatively inexpensive, with costs very similar to physical therapy, and the results of the studies have proven that acupuncture is a very viable noninvasive chronic pain treatment option.” Not that it works for everyone, but since we’re talking about having as many treatment options as possible from which to choose…
To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-january-27-mark-rxprofessor-pew/.
Until Next Week,