May 2014 John Weeks Integrator Round-Up: Integrative Pain Treatment
Samueli work in Pain Medicine underscores new directions in self care for integrative pain treatment The Volume 15, S1, 2014 issue of Pain Medicine, the official journal of the American Academy of Pain Medicine, is devoted to sharing outcomes ofSamueli work in Pain Medicine underscores new directions in self-care for integrative pain treatment The Volume 15, S1, 2014 issue of Pain Medicine, the official journal of the American Academy of Pain Medicine, is devoted to sharing outcomes of the Rapid Evidence Assessment of the Literature (REAL) self-care for pain completed by a team lead by Cindy Crawford at the Samueli Institute. The special issue is entitled, on the cover: Are Active Self-Care Complementary and Integrative Therapies Effective for Management of Chronic Pain? A Rapid Evidence Assessment of the Literature and Recommendations from the Field. The issue opens with a column from Samueli CEO Wayne Jonas, MD then follows with two powerful calls-to-action co-authored by former Army Surgeon General Eric Schoomaker, MD, PhD. Schoomaker is credited with stimulating the Department of Defense’s exploration of integrative practices.Comment: This is a coup, in a journal for some old line pain practitioners. Side note: Under my ACCAHC hat, referenced above, I was part of a team that chose to honor both Schoomaker and integrative pain leader, now deceased, Rick Marinelli, LAc, ND, by sponsoring Schoomaker's May 15, 2014 talk at the International Congress on Integrative Medicine and Health. It will run as the ACCAHC-Rick Marinelli, ND, LAc Lectureship. Schoomaker is a remarkable influencer. If only he'd had a chance to talk to the Canadian team, the NCCAM tweeter, and the HHS, below!U.S. Senate Committee on Veteran's Affairs promotes alternatives to pain drugs"With chronic pain affecting more than half of all veterans eligible for VA health care, the Senate Committee on Veterans' Affairs today looked at efforts by the Department of Veterans Affairs to increase access to therapies like acupuncture and yoga as alternatives to addictive narcotics." So opens the April 30, 2014 release from the Committee on Veterans Affairs. The hearing highlighted recent reports that "the department’s Opioid Safety Initiative launched last fall in Minneapolis already has begun to yield results. The facility has decreased its use of high-dose opioids by nearly 70 percent."Comment: Notably, especially given the item immediately below, in the release US Senator Bernie Sanders (I-VT) "praised the National Center for Complementary and Alternative Medicine at the National Institutes for Health for identifying non-narcotic alternatives to treating chronic pain and mental health conditions." They added: "The center has made groundbreaking contributions that helped expand viable and safer treatment options."US Health and Human Services on combating opioid addictions: Use more drugs!The U.S. Department of Health and Human Services recently published an editorial in the New England Journal of Medicine to "outline a national response to the epidemic of prescription opioid overdose deaths." The title of the press release from the agency on this publication read like this: "HHS leaders call for expanded use of medications to combat opioid overdose epidemic." The subhead noted that the commentary "describes that vital medications are currently underutilized in addiction treatment services and discusses ongoing efforts by major public health agencies to encourage their use." The April 23, 2014 NEJM article is entitled Medication-Assisted Therapies-Tackling the Opioid Overuse Epidemic. "Fortunately," the agency heads write, "clinicians have three types of medication-assisted therapies (MATs) for treating patients with opioid addiction: methadone, buprenorphine, and naltrexon." The commentary is devoted to ways these drugs might be more effectively pushed and initiatives underway to get them into people’s hands.Comment: It is beyond my expertise to judge whether greater use of these "MAT's" will be valuable components of an optimal solution to the nation's opioid addiction problem. But HHS’s failure to mention non-pharmacological approaches to treatment makes one wonder how closed a tribe is running our top non-military agencies on pain treatment. There seems to be a sort of "better dead than red" logic that forecloses on the ability of these leaders, amidst this crisis, to even mention the potential value in complementary and integrative approaches. Get your heads out of the sand! When will HHS be finally detailing a long list of agency initiatives to expand use of non-pharmacological approaches – self-care and clinician-delivered? The NCCAM blast, below, does not help.Twitter chat on CAM and back pain produces surprising dismissal of "CAM" from NCCAM tweeter The NIH National Center for Complementary and Alternative Medicine (NCCAM) held a Twitter chat (#nccamchat) on low-back pain on April 24, 2014. In the midst of it, an unidentified NCCAM staffer tweeted: "Don't use complementary approaches to replace conventional care or delay seeing a health care provider about a health problem." This stimulated one of NCCAM's top opponents to reply: "Better yet, just don't use CAM."Comment: This must be the comment of a newbie to NCCAM. The agency's own publications strongly rebuke this position - as the Sanders comment in the item on the US Senate hearing, above, notes. Nor is this what we hear from Josephine Briggs, MD, NCCAM director. Basically this says: Don't explore CAM to delay opioids! It would be good for Briggs to spend one of her blogs correcting this and explaining how this might have happened. The staffer was in engaging not it “groundbreaking contributions that helped expand viable and safer treatment options" but rather a cementing of prejudice-base policy.Canadian firm urges multidisciplinary approach to pain treatment, but with limited teamMeantime, across the border, Cira Medical Services has published a report showing that Chronic Pain costing Canadian economy up to $60 billion annually in lost productivity. They promote a multidisciplinary approach to bettering treatment and lowering costs. The study has the promising title of Chronic Pain: The Importance of a Multidisciplinary Approach to Diagnosis and Treatment [the link was broken when I sought to upload but they sent me a PDF]. The view of what might be considered on these multidisciplinary teams reached only as far as exercise, behavioral health and stretching. Massage is the only "CAM" that made their consideration.Comment: I contacted the Cira team with a link to some evidence that might have helped in "widening the circle" of who should be in these teams. It is a little surprising to see something out of Canada so retro.