EXECUTIVE SUMMARY EXECUTIVE SUMMARY PAIN MANAGEMENT BEST PRACTICES PAIN MANAGEMENT BEST PRACTICES INTER-AGENCY TASK FORCE REPORT Updates, Gaps, Inconsistencies, and Recommendations FINAL REPORT PAIN MANAGEMENT BEST PRACTICES INTER-AGENCY TASK FORCE REPORT 1 Submitted by the: Pain Management Best Practices Inter-Agency Task Force Report Date: May 9, 2019 Copyright Information: All material appearing in this report is in the public domain and may be reproduced or copied. Suggested Citation: U.S. Department of Health and Human Services (2019, May). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. Retrieved from U. S. Department of Health and Human Services website: https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html 2 TABLE OF CONTENTS Executive Summary .................................................................................................................................................................................. 1 Task Force Members ................................................................................................................................................................................ 5 Definitions .................................................................................................................................................................................................. 9 1. Introduction ............................................................................................................................................................................................ 11 2. Clinical Best Practices ......................................................................................................................................................................... 17 2.1 Approaches to Pain Management .................................................................................................................................................19 2.1.1 Acute and Chronic Pain ................................................................................................................................................................21 2.1.2 Perioperative Management of Chronic Pain Patients.........................................................................................................23 2.2 Medications ..........................................................................................................................................................................................23 Acetaminophen ............................................................................................................................................................24 NSAIDs ...........................................................................................................................................................................24 Anticonvulsants ............................................................................................................................................................24 Antidepressants ...........................................................................................................................................................24 Musculoskeletal Agents ..............................................................................................................................................25 Antianxiety Medications .............................................................................................................................................25 Opioids ...........................................................................................................................................................................25 2.2.1 Overdose Prevention Education and Naloxone ...................................................................................................................30 2.3 Restorative Therapies .......................................................................................................................................................................31 Therapeutic Exercise ...................................................................................................................................................31 Transcutaneous Electric Nerve Stimulation ............................................................................................................32 Massage Therapy.........................................................................................................................................................32 Traction ..........................................................................................................................................................................32 Cold and Heat ...............................................................................................................................................................32 Therapeutic Ultrasound ..............................................................................................................................................32 Bracing ...........................................................................................................................................................................32 2.4 Interventional Procedures ................................................................................................................................................................33 Epidural Steroid Injections .........................................................................................................................................34 Facet Joint Nerve Block and Denervation Injection ..............................................................................................34 Cryoneuroablation .......................................................................................................................................................34 Radiofrequency Ablation ............................................................................................................................................35 Peripheral Nerve Injections ........................................................................................................................................35 Sympathetic Nerve Blocks .........................................................................................................................................35 Neuromodulation .........................................................................................................................................................35 Intrathecal Medication Pumps ...................................................................................................................................35 Vertebral Augmentation .............................................................................................................................................35 Trigger Points ................................................................................................................................................................35 Joint Injections .............................................................................................................................................................36 Interspinous Process Spacer Devices ......................................................................................................................36 Regenerative/Adult Autologous Stem Cell Therapy .............................................................................................36 PAIN MANAGEMENT BEST PRACTICES INTER-AGENCY TASK FORCE REPORT i TABLE OF CONTENTS 2.5 Behavioral Health Approaches .......................................................................................................................................................37 Behavioral Therapy .....................................................................................................................................................38 Cognitive Behavioral Therapy ...................................................................................................................................38 Acceptance and Commitment Therapy ...................................................................................................................38 Mindfulness-Based Stress Reduction ......................................................................................................................38 Emotional Awareness and Expression Therapy .....................................................................................................38 Self-regulatory or Psychophysiological Approaches ............................................................................................38 2.5.1 Access to Psychological Interventions ....................................................................................................................................39 2.5.2 Patients with Chronic Pain as well as Mental Health and Substance Use Comorbidities .....................................40 2.6 Complementary and Integrative Health .......................................................................................................................................41 Acupuncture .................................................................................................................................................................43 Massage and Manipulative Therapies