Integrative leaders call for improved "pain science" policies

We need to implement better polices on pain science and integrative medicine, says Andrew Weil, MD, director of the University of Arizona Center for Integrative Medicine, and Victoria Maizes, MD, executive director of the University of Arizona Center for Integrative Medicine, in a recent blog post featured on The Hill.

On May 31, Dr. Francis S. Collins, the head of the National Institutes of Health (NIH), and Dr. Nora Volkow, the head of the National Institute on Drug Abuse (NIDA), published an article in the New England Journal of Medicine titled, "The Role of Science in Addressing the Opioid Crisis." The article has received backlash in the integrative healthcare community as the only science addressed in it concerned pharmaceutical drugs.

This focus goes against current recommendations from major public health organizations, including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Joint Commission, who suggest non-pharmacological interventions be first priority in treatment.

Professional organizations and associations echo this call for non-drug approaches to pain. In February, the American College of Physicians published practice guidelines on low back pain, stating, "clinicians and patients should initially select non-pharmacological treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation."

Both Weil and Maizes say it is disconcerting that leadership in the NIH and the NIDA would omit non-pharmacological approaches to pain management, especially considering their influence in the policy and research landscape. Further, the organization's priorities are out of point with the integrative industry. The most cost-effective and least invasive practices, which need and deserve further research, are completely ignored.

Weil and Maizes called for more awareness and research on alternative treatment methods and a focus on integrating non-drug therapies with pharmacological approaches when appropriate. "Opioids are the best medications we have for moderate-to-severe acute pain," they write. "[When] used appropriately, they are effective and relatively safe. As stand-alone treatment for chronic pain, however, they neither safe nor effective."

With more and more patients presenting with chronic pain and seeking relief, practitioners must understand the differences from acute pain, they say. Chronic pain often results in comorbidities like fatigue, depression, and cognitive impairment, conditions acute pain patients do not experience. Practitioners often treat chronic pain patients the same as acute pain patients, which Weil and Maizes say must be corrected.

Newer, integrative approaches to pain management offer individualized treatment, incorporating many different modalities coordinated by a team of healthcare professionals. "Analgesic medication is a component of this approach but never the sole component or even the most important one," they write.

Initiatives such as those from the Oregon Pain Management Commission’s  and the Veteran's Administration (VA) back away from opioids as a central course of treatment, and instead promote integrative therapies for chronic pain in addition to conventional care, including acupuncture, massage, manipulation, yoga, and supervised exercise and physical therapy.

Weil and Maizes call for more states to follow Oregon and the VA and mandate policies that address the new science of chronic pain with integrative approaches rather than punishing users or prescribers of analgesic medication. Further, they write that additional policy changes would support funding for pharmaceutical-government partnerships, as well as for cost and clinical effectiveness outcomes research. Funding is also needed to assess the affect of new education programs on integrative pain management, evaluating changes in prescribing behavior of providers, as well as patient satisfaction, they say.

Click here to read the full blog post.