Does the New National Pain Strategy Respect Integrative Pain Treatment?

by John Weeks, Publisher/Editor of The Integrator Blog News and Reports

On March 18, 2016, the U.S. Department of Health and Human Services (HHS) issued the National Pain Strategy. The Oversight Panel for the HHS strategy included no experts from the integrative health and medicine community. The 6 working groups who work informed the strategy included just one well-known professional in integrative medicine, University of Maryland integrative medicine leader Brian Berman, MD, among their 80 members. This leaves us to question whether this new national pain strategy respects integrative pain treatment protocols.

Would you guess that integrative health and medicine practices and practitioners were highlighted as having much of a role in the nation’s new direction?

My column in the Huffington Post offers a full analysis of the level of inclusion. The introductory, summary section would dismay most integrative pain advocates. The Strategy’s vision and executive summary seemed to prove that the die was cast when HHS chose to not include integrative leaders in its circles of advisers. Six paragraph length summaries of working group activity offered no mention. In fact, of the 14 separate bullet points in the “vision” statement guiding the work, just one mention pops up. The "role of complementary and integrative medicine" is buried at the bottom of a half dozen items in the 8^th bullet. This piece of the vision itemizes new areas that should be increasingly part of clinician education. Notably, this one mention was related to the working group with which Berman was involved.

Opportunities for Integrative Practitioners as "Collaborators"

The analysis reported 15 separate mentions of licensed complementary or integrative health practitioners and methods. The most notable were 4 places where these practitioners were included as collaborators to meet one of the “objectives” prioritized by the working groups.

• Service Delivery & Payment, Objective #1 - urged the inclusion of "licensed integrative health practitioners"

  • "Define and evaluate integrated, multimodal and interdisciplinary care ..."

• Service Delivery & Payment, Objective #3 - reached out to "licensed integrative health care providers"

  • "Tailor payment to promote and incentivize high-quality, coordinated pain care ..."

• Disparities, Objective #1 - called for the inclusion of "social service providers (including licensed practitioners who provide integrative and complementary health approaches)."

  • "Reduce bias (implicit, conscious, and unconscious) and its impact on pain treatment by improving understanding ..."

• Prevention and Care, Objective #2 - invited collaboration with "licensed complementary and integrative health fields."

  • "Develop nationwide pain self-management programs..."

Integrative health practitioners did not warrant specific mention in any of the 13 other objectives, including all of those related to 3 of the working groups: Population Research, Professional Education and Training, and Public Education and Communication. The analysis in the Huffington Post notes that “health care professionals," "health care professional organizations," or "other relevant health disciplines" are recommended collaborators in many of the other objectives.

While the Strategy recommends wholistic biopsychosocial and multidisciplinary approaches, the document is dominated by the national concern for opioids. They merited 66 mentions in the 55-page document.

 Comment: When I undertook the analysis, I was surprised – given the dearth of representation – to find even this level of inclusion. The opportunities for moving integrative practitioners into the mix as collaborators are significant. As previously reported here in the Integrative Practitioner, national organizations representing chiropractors, naturopathic doctors, and acupuncturists have announced their interest in getting further into the game.

That said, it’s too bad that HHS chose not to respect the value given to non-pharmacologic strategies by, for instance, the hospital accreditor, the Joint Commission. Imagine the document if the Oversight Committee and working groups had each been integrated with a mix of chiropractors, integrative medical doctors, naturopathic physicians, doctors of acupuncture and Oriental medicine, massage and yoga practitioner-researchers. There is good in this Strategy – just not nearly as much beneficial guidance as would have flowed from an openly inclusive process.