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Workshop Agenda

The Role of Nonpharmacological Approaches to Pain
Management—A Workshop

December 4–5, 2018
National Academy of Sciences Building
2101 Constitution Avenue, NW, Washington, DC

Background:

Pain is a leading cause of disability in the United States. Given the complexity and biobehavioral nature of pain, the 2011 Institute of Medicine report Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research advocated for multifaceted approaches for pain management composed of both pharmacological and nonpharmacological therapies. In 2017, the National Academies of Sciences, Engineering, and Medicine’s report Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use reviewed the status of available evidence on nonpharmacological therapies for managing chronic pain. For example, cognitive behavioral therapy (CBT), a type of psychotherapy focused on restructuring negative thoughts and experiences with positive expectations, has been shown to be effective in reducing pain intensity and other psychological effects caused by pain (e.g., anxiety and depression) for low back pain, headaches, arthritis, orofacial pain, and fibromyalgia.

As a result of this national push toward the use of nonpharmacological therapies for chronic pain, increased health professional education and train-

ing will be needed to encourage the adoption and appropriate use of the evidence-based approaches. In addition, addressing policy barriers, such as those related to reimbursement for these treatments, will be important to enable broader use and dissemination. Given the changing landscape for pain management, the Forum on Neuroscience and Nervous System Disorders and the Global Forum on Innovation in Health Professional Education will bring together key stakeholders to discuss these treatments and integrative health models for pain management.

Workshop Objectives:

• Review the current state of evidence on the effectiveness of nonpharmacological treatments and integrative health models for pain management as well as available evidence on use patterns and patient interest. Examples may include acupuncture; manual therapies; physical therapy, occupational therapy, and exercise; cognitive behavioral therapy; tai chi; yoga; meditation; and neurostimulation.
• Explore the state of evidence on the effectiveness of emerging models of pain management.
• Consider multimodal approaches and potential synergies between and among pharmacological and nonpharmacological approaches to pain management.
• Consider multimodal approaches and potential synergies between and among devices and nonpharmacological approaches to pain management.
• Discuss research gaps and key questions for further research.
• Examine health professions’ current approaches for educating students, trainees, and practicing clinicians on nonpharmacological pain management, and discuss potential next steps to improve training and education within and across health professions.
• Explore policies, such as those related to reimbursement that would enable broader dissemination and implementation of evidence-based nonpharmacological treatments when appropriate.

DAY ONE: December 4, 2018

Objectives:

• Describe the treatments used for pain problems covered by insurance and patient use of complementary and integrative health approaches often not covered by insurance.
• Review evidence for the effectiveness and cost-effectiveness of nonpharmacological treatments for pain management.
• Describe the impact of psychological and social factors on patient responses to pain and pain treatments.
• Explore the state of evidence on the effectiveness of emerging models of pain management.
• Consider multimodal approaches and potential synergies between and among (1) pharmacological and nonpharmacological approaches; and (2) devices and nonpharmacological approaches to pain management, and for whom.
• Discuss research gaps and priorities for further research.

Objective:

• Examine health professions’ current approaches for educating students, trainees, and practicing clinicians on nonpharmacological pain management.

DAY TWO: December 5, 2018

Objective:

• Discuss potential next steps to improve training and education for pain management within and across health professions.

Objectives:

• Explore policies, such as those related to reimbursement, that would enable broader dissemination and implementation of evidence-based nonpharmacological treatments when appropriate.
• Discuss potential policy barriers and opportunities for innovation.
• Consider the research and evidence needed to advance these policies.

Objective:

• Synthesize and discuss key highlights from the workshop presentations and discussions and, most importantly, identify next steps and promising areas for future action and research.

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