by Amanda Conschafter, blog editor
New legislation has the House Committee on Veterans Affairs examining a far-reaching patient access issue: pain management for former U.S. service members. More than 50 percent of veterans experience chronic pain, explain two dozen patient advocacy organizations in a letter to the committee. And now, advocates explain, the Promoting Responsible Opioid Management and Incorporating Medical Expertise (PROMISE) Act could encourage clinicians to tailor treatment to individual veterans – choosing from among the full range of pain management options.
For one, the letter states, legislators can use the bill to elicit an updated Veterans Health Administration directive on the use of stepped care. The “comprehensive, escalating and interdisciplinary approach” to pain management is a best practice model acknowledged by the Institute of Medicine. The previous VHA directive embraced stepped care but expired before the model was fully implemented. A follow-on directive could renew VA clinicians’ emphasis on comprehensive care for veterans.
But not all of the bill’s provisions are wins for veterans, the letter argues. The PROMISE Act suggests updating VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Painunder the “presumption” that current guidance is ineffective. The letter notes that the guideline’s “treatment algorithms” complement electronic health records and support clinicians as they select from an array of pain management treatments. Sensitive to the potential for addiction or abuse of opioid analgesics, the guideline also incorporates risk-benefit evaluation, patient assessment and “consideration of other treatment modalities prior to initiative a trial of opioid therapy.”
Moreover, the letter points out, the guidelines reflect the input of a broad, multidisciplinary working group that reviewed scientific literature and available evidence through a “rigorous” review process. If the guidelines require updating, the letter argues, it should be at the discretion of an equally balanced group of professionals using a similarly scientific evaluation method.
The Alliance for Patient Access signed the letter to the House Committee on Veterans Affairs, as did the U.S. Pain Foundation, the Hospice and Palliative Nurses Association, and the Alliance for Aging Research, among others.