Chronicles of Health Creation: 'Never Only Opioids" Urges Imperative for Integrative Medicine in Pain Care'

Integrative medicine and complementary health practices and professionals have been listed in some pain guidelines of the dominant school of medicine since at least 1999. Usually they are buried, a last resort. If all else fails, try acupuncture. If all else fails, see a chiropractor.

A new eight-page, policy brief, "Never Only Opioids: The Imperative for Early Integration of Non-Pharmacological Approaches and Practitioners in the Treatment of Patients with Pain" argues that it is long past time for the last to be first -- to reverse this order and always bring integrative care options up front, as least as complements.

The paper is the product of a major national coalition involving over 40 organizations, the Pain Action Alliance to Implement a National Strategy (PAINS). A media release is here.



Perhaps most important for the transformation of pain care, the paper comes with a separate set of 13 Recommendations to leverage change: for Educators (3), Federal Agencies (3), Delivery Systems (4) and Research Funders (4). Included in this document are aspects of the Affordable Care Act that promote and support such a shift.

PAINS urges use of the "Never Only Opioids" policy brief and recommendations as action tools to transform the way pain is treated. Organizations can have their own hard-copies made.

The paper opens with reference to former US Army Surgeon General Eric Schoomaker, MD, PhD urging in a May 2014 plenary talk that there is such an "imperative for for integrative medicine in the military." The plight of wounded warriors has vastly expanded military initiatives to explore alternatives to pharmaceuticals and surgery. Some 213,000 "complementary and alternative medicine visits" were offered in 2012 in a total of 120 different facilities.

Do we have a similar imperative in the civilian population? The authors of "Never Only Opioids" make their case on two sources of evidence. First: the personal devastation and public health challenges from current, drug-focused pain practices. They note: "Immeasurable personal costs of chronic pain are linked to $300 billion in additional health care costs and $335 billion in lost productivity."

Second: mounting evidence, through research engaged via the National Institutes and elsewhere, that multiple complementary and alternative medicine practices and practitioners can be useful for people with pain. The authors note evidence of cost-savings cited in an Institute of Medicine Report: "Overall, CAM users had lower average expenditures than nonusers ($3,797 versus $4,153). Their outpatient expenses were higher, but offset by lower expenses for inpatient care and imaging. People who had the heaviest disease burdens accounted for the highest levels of savings, an average of $1,420."

Schoomaker has weighed in with his view that this "imperative" exists in civilian care. In a September 29, 2014 presentation at Georgetown University, the former Army Surgeon General added an additional perspective. He noted that poor health and particularly obesity in young people is limiting the number of would-be recruits who are fit for duty. Their health, in his view, is a "national security" issue. He sees the integrative health and medicine values, practices and professions as critically important agents of change in the nation's movement toward reversing these trends.

I was a proud member of the interprofessional team that wrote "Never Only Opioids" for PAINS. Involved were: Heather Tick, MD, on integrative MD with an endowed position in integrative medicine at the University of Washington; Kevin Wilson, ND, a gubernatorial appointee to the Oregon Pain Commission; Arya Nielson, PhD, LAc, an integrative medicine leader at Deaconess Medical Center in New York; Bill Meeker, DC, MPH, the president of Palmer College West and originally the principal investigator on the NIH's chiropractic research center; and the team leader, Martha Menard, PhD, CMT, a massage therapist and research methods specialist. Our work was supported via an unrestricted grant from NCMIC Foundation.

We are each part of the Task Force on Integrative Pain Care for one of the PAINS member organizations, the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). Menard sits on the PAINS Steering Committee.

Together with PAINS we urge you to engage your activist selves. 1) read and learn; 2) circulate the policy brief and recommendations to your lists; 3) urge your organizations to endorse the recommendations; 4) promote via your social media; 5) post/link on your website; 6) use in education and presentations; 7) put info in your sites or newsletter; 7) write about it; 8) print and use the two-pager as a handout and door-opener; or 8) order hard copies for multiple uses, via the link above.

An integrative center consultant Glenn Sabin wrote to me on seeing the document: "Real impressive piece of work. Congratulations to you and all those involved. Content creation like this is such a laborious process."

Then he added: "What concerns me most about these types of policy papers, is the [low] level of forethought and commitment that goes into the messaging, dissemination and promotion of the resulting compelling content, which tends to be zilch."

Please help get "Never Only Opioids" and the recommendations out into our communities to help leverage the transformation of pain care!