11

Key Challenges and Opportunities in Chronic Pain and Disability

In the workshop’s final session, planning committee members presented their key takeaways from sessions they moderated.

Session 1: Factors Affecting Access to Effective Chronic Pain Care (Tamara Baker, professor of psychiatry, University of North Carolina at Chapel Hill).

• Social and structural determinants of health must be considered by clinicians, researchers, and policy makers with regard to access to and availability of care and treatment.
• Age and race are important characteristics and must also be considered in future plans and next steps.

Session 2: Methods and Metrics for Chronic Pain Assessment in Adults and Children (Reuben Escorpizo, clinical professor, University of Vermont College of Nursing and Health Sciences).

• Pain is a multidimensional, individualized, biopsychosocial, and temporal experience.
• A biopsychosocial perspective on chronic pain is essential, requiring a holistic manner of assessment.
• Assessment requires observational, performance-based, and self-report measures that together are powerful tools for informing disability determination decisions.
• Challenges include standardizing both assessment and reporting for comparability and benchmarking.

• Patients must be an active part of the measurement and treatment development process.

Session 3: Best Practices and Clinical Perspectives on Chronic Pain Treatment and Management in Children (Henry Xiang, professor of pediatrics and epidemiology at the Ohio State University and director of the Center for Pediatric Trauma Research at Nationwide Children’s Hospital).

• Data are critical for allocating resources, but there is a lack of comprehensive data on chronic pain experience, etiology, and treatment outcomes in children, and on the proportion of children with chronic pain who transition to adulthood with chronic pain.
• An important research question is how early intervention during childhood reduces the likelihood that an individual will file for disability claim as an adult.
• A triage system is needed to identify children who need treatment in the limited number of comprehensive treatment programs versus those who can receive treatment at a community hospital or primary care office.
• Research on innovative technologies must involve more patients and their families to ensure that the technologies are relevant and accessible.

Session 4: Best Practices on Chronic Pain Treatment and Management in Adults (Christopher Standaert, associate professor of physical medicine and rehabilitation services at the University of Pittsburgh School of Medicine).

• Effective chronic pain treatment focuses on improving the individual’s quality of life in meaningful ways. However, this is difficult to achieve within the fragmented and financially driven U.S. health care system.
• Clinicians do not spend enough time talking to their patients about their lives, needs, and wants, and they do not explain the harms of possible treatments in a way that helps them decide on a course of action.
• Physical movement, physical capacity, and psychological well-being are central to chronic pain care and high levels of functioning.
• Within the U.S. health care system, there is a need to emphasize non-pharmacologic and noninvasive therapeutic options, such as tai chi and pain psychology, that are effective at treating chronic pain.

Session 5: Patient Journeys and Clinician Perspectives in Treating and Managing Chronic Pain (Anna Williams, vice president, Clusterbusters, and Juan Hincapie-Castillo, assistant professor of epidemiology at the University of North Carolina at Chapel Hill).

Anna Williams:

• Many people living with chronic pain experience grief, fear, and humiliation and feel helpless and unheard; there is a communication disconnect when patients don’t understand medical jargon or fit into neat diagnostic categories.
• Patients value a sense of dignity, provider emphasis on quality of life, and empowerment with their choice of treatments.
• Stigma and health care disparities of care related to geographic location, race, age, and other factors impede effective management of chronic pain.
• Each individual experiences chronic pain differently.

Juan Hincapie-Castillo:

• Limited continuity of care and care coordination among providers creates significant challenges for underserved and uninsured populations.
• Those living in rural areas face challenges accessing effective complementary and alternative therapies.
• The lack of physicians trained in pain management creates opportunities for collaboration with other clinicians, such as clinical pharmacists.
• Clinicians receive insufficient training in pain management and disability claim criteria.
• Doctor shopping, which can be a concern for Social Security disability adjudicators, could be a reflection of patients facing discrimination in their care and advocating for themselves to get the care they need.
• Even when chronic pain is controlled, significant impairment and disability can persist, which creates challenges for Social Security disability adjudicators.

Sessions 6 and 7: Health Care System Challenges in Comprehensive Chronic Pain Management, and Complementary and Alternative Therapies in Comprehensive Chronic Pain Management (Kim Dupree Jones, professor and associate dean for academic advancement at Emory University).

• Chronic pain is multisymptomatic, requiring measurement of multiple domains to determine the most appropriate treatment options.
• Physical therapy, home exercise, and mindful movement are evidence-based, effective therapies that improve pain, reduce fatigue, and improve sleep, and the U.S. health care system needs to more readily adopt them.

Session 8: Emerging Research on New or Improved Methods for Measuring and Managing Chronic Pain (Sean Mackey, Redlich Professor of anesthesiology, perioperative, and pain medicine, chief of the division of pain medicine, and director of the Stanford Systems Neuroscience and Pain Lab at Stanford Medical School).

• New interventions, including medications, neuromodulation, and mind-body approaches, are in development, but there is a need to accelerate the pipeline from idea to implementation.
• The research community needs to provide higher-quality data to help the Social Security Administration streamline the disability application and determination process.
• To obtain the required data, clinicians must be equipped with improved methods for capturing them, which includes financial incentives that align with this goal.