Last week the U.S. government released the new CDC opioid prescribing guidelines, closely followed by the National Pain Strategy. Like an addict coming off of a 20 year bender, the federal government has finally woken up to the fact that much life has been wasted and something different has to be done.
The CDC opioid prescribing guidelines advise prescribing opioids as seldom as possible, in as small a dose as possible, for as short a time as possible. The guidelines advise that opioids for acute care be limited to 3-7 days. Though these recommendations are highly controversial, the reality, acknowledged in the recommendations, is that millions of Americans, many using the medications for pain as prescribed, have become addicted and 169,000 have died. At the same time, there is no evidence that opioids are an effective treatment for chronic, non-cancer pain.
To my mind, this is all good. Where the recommendations fall short is in advising doctors and patients what to do instead. Vague references are made to physically therapy and psychotherapy, without adequately addressing the fact that these therapies, while often effective for chronic pain, are either out of the financial reach or out of the geographical reach of most pain patients. More than 93 million Americans live in mental health shortage areas, where there is less than one mental health provider per 10,000 people. Physical therapist shortages are growing too, with the American Physical Therapy Association predicting a shortage of 40,000 therapists by 2020. Even where physical therapy is available, insurance companies have been allowed to severely restrict the number of visits they will cover and to impose high co-pays.
Dozens of experts contributed to the National Pain Strategy, which was five years in development. Yet there was not a single acupuncturist, chiropractor, massage therapist, exercise physiologist, physical therapist, nutritionist or naturopath on the panel. As a result, despite the enormous potential of these therapies to heal pain, they were completely ignored in the proposed plan. Instead, an intensive five year effort to find better pain treatments was recommended, as well as finding ways to "incentivize" doctors to provide better pain treatment.
This is an outrage. Please join with me in demanding that President Obama and Congress pass legislation that requires that doctors be educated in alternative pain treatments and that insurance covers them at a level that allows affordable access for pain patients and a sustainable income for health care providers. Please sign my petition on change.org here: Pain Treatment Parity Act Petition