Summary

AHRQ has undertaken three rapid evidence products and two systematic reviews to inform Medicare coverage and payment for treatment of acute and chronic pain. The work was done in support of the Dr. Todd Graham Pain Management Study, section 6086 of the SUPPORT Act.

Medicare beneficiaries and other people with acute and chronic pain often receive treatment that does not successfully address pain, resulting in profound physical, emotional, and societal costs to them and their families, friends, and caregivers. Centers for Disease Control and Prevention data indicate 50 million adults in the United States have chronic daily pain, with nearly 20 million experiencing high-impact pain that interferes with daily life or work.¹ At the same time, the country is also coping with an opioid and substance use disorders crisis that involves shifting "waves" of overdose deaths associated with heroin, synthetic opioids, and prescription drugs, and intensifying polysubstance use. The country is also experiencing the COVID-19 public health emergency, which poses its own challenges for individuals, and the healthcare system.

Opioid analgesics play an essential role in treating pain, and pain management in the context of the nation’s substance use crisis has rapidly evolved beyond an opioid-centric approach. Clinicians and healthcare systems need more information about multimodal pain care options in outpatient and inpatient settings to effectively treat Medicare and other patients with pain, and people with both pain and either active or historic substance use disorders, including knowledge about complementary care, analgesic medications, and medical devices that are potentially effective.

The rapid evidence products are:

• Care Coordination and Care Plans for Transitions Across Care Settings 
• Treatments and Technologies Supporting Appropriate Opioid Tapers 
• Treatments, Technologies, and Models for Management of Acute and Chronic Pain in People With a History of Substance Use Disorder

The systematic reviews are:

• Interventional Treatments for Acute and Chronic Pain
• Integrated and Comprehensive Pain Management Programs: Effectiveness and Harms

Reference

1. Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults—United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI: 10.15585/mmwr.mm6736a2.