VA’s integrative pain initiative shows early positives in limiting opioid dependency The US Veteran’s Administration recently sent a media release announcing that VA Initiative Shows Early Promise in Reducing Use of Opioids for Chronic Pain. The article notes that the

American Academy of Pain Management calls on insurers to cover integrative approaches as part of multidisciplinary, team approach to chronic pain

American Academy of Pain Medicine has issued a release entitled Pain Physicians Say Insurance Coverage Falls Short. The media notice followed passage of a position paper entitled Minimum Insurance Benefits for Patients with Chronic Pain at the organization’s 2014 annual meeting. The paper “called on insurance payers to provide adequate coverage for interdisciplinary pain care, including physical therapy, massage, yoga, acupuncture and other alternative therapies.” The perspective lambastes a reductive approach to coverage that increases opioid dependency: “Patients with persistent, ongoing pain experience endemic barriers to care, many related to non-existent or insufficient insurance coverage and reimbursement for evidence and consensus based therapies. The result is a reductionist approach to pain management whereby the default treatments are prescription (often opioids) and procedural.” Here is the key statement:

“In all tiers of the healthcare system, from the uninsured to those on public and private plans, coverage is needed for comprehensive, interdisciplinary modalities of treatment like CBT [cognitive behavioral therapy], physical therapy, stress management, rehabilitation, complimentary [sic] and integrative therapies (CIM) and alternative therapies and medications that are known to be effective and safer than usual care. At minimum, all payers should provide three months coverage for an interdisciplinary integrative pain evaluation and treatment program for people with pain that is severe enough to warrant ongoing therapy that has failed or is not expected to respond to first-line therapies and that is not expected to resolve in the foreseeable future.”

Comment: The fit of this call for reimbursement change with the findings from the early VA work to limit dependence on opioids could not be better. Notably – and unfortunately – the paper does not specifically address the benefits that could flow from a broad interpretation of the Non-Discrimination in Health Care provision, Section 2706, of the Affordable Care Act. (See Sections on CAM and Integrative Health in the Affordable Care Act-HR 3590.)

American Academy of Neurology issues guidelines for CAM and multiple sclerosis – cannabis high on list 

The American Academy of Neurology has issued a guideline on “CAM” and multiple sclerosis in which only cannabis is high enough on the team’s scale to merit a recommendation. The March 24, 2014 release was entitled “Guideline: Medical Marijuana in Pill Form or Oral Spray May Ease Some MS Symptoms; Little Evidence Other Complementary or Alternative Therapies Work.” An AAN Patient Summary notes “weak evidence” that supports use of Gingko Biloba, reflexology and magnetic therapy. This AAN page guides one to evidence and conclusions. The AAN has engaged a significant outreach effort to promote its new guideline.

IN-CAM Research Network announces 10th Anniversary Research Symposium: The Next Wave

The theme of the 2014 IN-CAM Research Symposium is “The Next Wave of Complementary & Integrative Medicine Research.” The meeting will take place Nov 6-8, 2014 in Calgary, Alberta. Keynote talks will be offered by Dr. Rogers Prize-winner Sunita Vohra, MD, Georgetown-based IM-educator, Aviad Haramati, PhD, Rand Corporation cost-effectiveness expert Patricia Herman, PhD, ND, and University of Saskatchewan complementary medicine research leader Michael Epstein, PhD. Abstract submission deadline is June 30, 2014. IN-CAM’s current acting director is Ania Kania-Richmond.

Comment: This Canadian network has done exceptional work in its decade of existence. We have nothing like it in the United States. The organization’s co-founders and co-advisors Heather Boon, PharmD, and Marja Verhoef, PhD are international leaders in highlighting the need to expand our abilities and capacity to research whole practices and whole systems. One sample: Boon is among those on a panel that will be a “soap-box” on research methods at the International Research Congress on Integrative Medicine and Health. The IN-CAM Outcomes Database is a gift to all interested in coming to understand the value of these practices and disciplines in the real world. An early congrats on 10 years!

Massage Therapy Foundation engages research project with Samueli Institute

The Massage Therapy Foundation (MTF) has selected the Samueli Institute to lead an exploration of the impact of massage therapy on chronic pain, and “to identify gaps in knowledge that can help direct future research” according to this release. To begin the work, the two organizations convened a round table discussion with leaders and subject matter experts in both massage and pain management in February 2014. The goal was to formulate a clear research question, namely: “What is the state of the science regarding the impact of massage therapy on function for those experiencing pain?” The project will also “develop criteria that will be beneficial for use in future research articles for integrative medicine.” The project is funded by the Massage Therapy Foundation with the ongoing support of the American Massage Therapy Association.

American Public Health Association’s “CAM” group changes name

The co-director of the special interest group concerned with “CAM” within the American Public Health Association (APHA), Beth Sommers, LAc, PhD, has shared with the Integrator that the group, which has been called the Alternative and Complementary Health Practices group since being formed in 1994 has “officially changed our name.” The change came through a vote among members. The winner: “Integrative, Complementary and Traditional Health Practices.” States Sommers: “It’s a mouthful, but our name expressed the comprehensive and global reach of our work. We use the term ‘health practices’ to signify the importance of self-care and self-help strategies as well the use of practitioner-based interventions.”

Comment: In the move for “good medicine” – that is inclusive, respectful, and multidisciplinary our language must be continually re-adjusted. This looks an enduring handle.

AHA, hospital transformation and leadership from the CEO of Hospital Corporation of America: health creation?

The cover story in the American Hospital Association’s Hospitals and Health Networks flagship magazine showed Jonathan Perlin, PhD, MD, CEO of Hospital Corporation of America (HCA) in pin-stripe suit, maroon power tie against a silvery-glass backdrop that evokes the fine interiors of high end hospitals. The title: “Toward a Healthier Tomorrow.” Perlin, the chair-elect for the organization is characterized as welcoming “a powerful, positive, transformation of health care in America.” Inside the feature, a subsection is entitled “From Sick Care to Health Care.” Perlin speaks of how hospitals “have been honed to focus on sick care,” adding: “It is a tough transition, but we have to learn how to move from sick care to health care.” Then: “I’m not sure that any of us – big system; small, rural hospital; academic health center; government; or private sector – fully understands or knows the recipe.” He believes the AHA can be a powerful convener for making the change.

Comment: First, it is a good thing that hospital leaders are distinguishing the two types of care. The humility – “I am not sure any of us fully understands or knows the recipe” – echoes the perspective of Don Berwick, MD when he called recently for a move toward “health creation” as the focus of the industry. Perrin’s bio is intriguing, pairing leadership of the for-profit behemoth HCA with a leading role in the Veteran’s Administration’s transformation during the heyday of its early reform under the visionary leadership of Kenneth Kizer, MD. Notably, the same issue of H&HN included a feature on the money saving value in better linking medicine to mental health care (Mind+Matter=Health Care’s New Math). These are birth tremors. The truly tough thing for hospitals is that we need to shrink them, in favor of outpatient models. Can Perlin and the AHA lead that? Still, this move away from merely “sick care” is an opportunity for leadership from integrative health and medicine.