New pain treatment guidelines underscore a now familiar disconnect: the gap between what patients need and what their health plans will pay for.

The American College of Physicians reviewed more than 150 studies to produce “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain,” published in the Annals of Internal Medicine.  The group recommends multidisciplinary approaches before opioids.

Guidelines instead point to evidence for spinal manipulation, massage and acupuncture to treat pain that lasts up to 12 weeks, as well as NSAIDs such as ibuprofen.  For chronic pain, the guidelines encourage exercise, multidisciplinary rehabilitation, yoga and cognitive therapy.  They also acknowledge the value of short-acting opioids and antidepressants.

These options represent core components of balanced pain management.  Anita Gupta, MD, steering committee member of the Alliance for Balanced Pain Management and vice chair of Drexel University College of Medicine’s division of pain medicine, reiterated the importance of mental well-being in particular.  Dr. Gupta explained to The Philadelphia Inquirer that she often encourages family and friends to participate in patients’ treatments and recommends psychotherapy to ward off patients’ depression and isolation.

But physicians acknowledge that a multidisciplinary approach is still not the norm.  Not all patients recognize the value of non-pharmacologic responses, Dr. Gupta explained.  Patients in pain understandably want the quickest relief possible.

Cost and coverage present another barrier.  The American College of Physicians’ guidelines relegate opioids to the last resort, advising that the drugs be used “only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits.”  Yet health plans may be more likely to cover prescription opioids – many available in inexpensive generic forms – over biofeedback sessions, acupuncture, or a more costly combination of non-pharmacologic treatments.

Thus, physicians who treat patients in pain may find themselves once again forced to choose between what’s safe and effective for patients – and what’s affordable under their health plan.

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