President's Message

Stemming the Tide of the Pain and Opioid Crisis: AAPM Reaffirms Its Commitment to Multidisciplinary Biopsychosocial Care and Training

Headlines: “President Trump announces Governor Christie to lead charge to fight the opioid epidemic.”

Reporter: “A comment from the AAPM, please.”

AAPM President: “The President’s decision to appoint the task force gives us an opportunity to respond to a serious crisis and help the public and stakeholders understand the breadth of ‘pain management.’”

On March 29, as part of the ongoing barrage of news stories around the ongoing opioid overdose epidemic, President Trump announced from the White House that New Jersey Governor Chris Christie had been selected to lead a task force including federal and state authorities, physicians, and advocacy groups to fight the opioid epidemic. As has been the case with earlier governmental agency announcements and initiatives around opioids and pain care, such as the US Centers for Disease Control and Prevention Opioid Guideline release in March of 2016, a media frenzy quickly ensued. Soon after the Gov. Christie announcement, media requests for comments quickly started coming into the American Academy of Pain Medicine (AAPM) offices. As our new president, I took the calls to help answer questions on behalf of the Academy and our field, pain medicine.

The initial questions were pretty straightforward surrounding what AAPM thought about a Federal Task Force headed by Gov. Christie. AAPM supports and welcomes any intervention on behalf of the federal government and state agencies to better understand and help manage the ongoing crisis of prescription opioids, escalating heroin, and illicit fentanyl addiction and overdose deaths. But any intervention must be balanced with maintaining quality evidence-based comprehensive pain care for patients—pain care that is based on individual needs and biopsychosocial factors and supports a wide range of pharmacologic and nonpharmacologic therapies for pain.

After completing numerous 30- to 40-minute interviews with writers from various media outlets, an important theme began to emerge. In a number of instances, the writers demonstrated little understanding of the breadth of pain management, separate from a focus on “pain killers.” Most writers’ honest follow-up questions included “So, what other options do patients have besides opioids?”

If AAPM is to be part of any success in decreasing prescription opioid misuse and addiction, it will require a concerted effort to improve and better disseminate the essential groundings in “multidisciplinary care” that formed a seminal part of our training as pain specialists. Pain management has never been just about “pain killers” or a medicine-centric approach to care. We need to help educate a public with limited knowledge of nonpharmacologic interventions that is bombarded by direct-to-consumer advertising about various medication therapies.

The foundation and critical components of multidisciplinary care include:

• behavioral health interventions (i.e., cognitive behavioral therapy, mindfulness based stress reduction);
• interventional procedures (i.e., spine injection procedures, peripheral nerve injections, neuromodulation);
• physical and occupational therapies;
• exercise and wellness regimens;
• acupuncture, massage, and other integrative health therapies;
• musculoskeletal care (i.e., soft tissue injections, ultrasound- guided procedures);
• medication management focusing on improving analgesia, psychosocial function, and sleep;
• a rational individualized medication regimen that is selective, mechanism-based, and focused on improved function and patient safety;
• team-based interdisciplinary care;
• addiction and substance abuse treatment;
• patient education.

The theme of the AAPM 2018 Annual Meeting will be to re-engage our members and, most importantly, stakeholders (i.e., payers, patients, and the public) around AAPM’s commitment to multidisciplinary care. Our mission of “advancing the comprehensive care of patients with pain through promotion of the best clinical practices, research, advocacy, and continuing medical education” ideally reflects this important shift away from the public’s misconstrued and narrow focus on analgesics (i.e., opioids, anti-inflammatories) as the mainstay for clinical care for chronic pain.

Within any crisis lies an opportunity. Our opportunity as an Academy is to help lead the charge to re-educate stakeholders. Together, we can raise awareness about the wide range of treatments to help patients suffering from pain and pain-related psychosocial dysfunction as a means of helping patients regain their quality of life while minimizing adverse effects on patients and the public.

Follow-up Story
If we remain committed to these efforts, headlines in the future will be discussing advancements in multidisciplinary care, telling stories about patients returning to a greater quality of life whether they were successfully implanted with a spinal cord stimulator device, completed a comprehensive pain rehabilitation program, or finished a life-changing round of cognitive behavioral therapy. This “multidisciplinary” approach has been the foundation of our Academy for over 30 years. Today, it’s more important than ever that AAPM take a leadership role in reminding our colleagues, the public, and concerned stakeholders about the importance of delivering the right care for patients suffering pain.

Steven P. Stanos, DO
President, American Academy of Pain Medicine

View Previous President's Messages