Opioid Reduction Consensus Panel
Pain management experts and patient advocates met in April 2019 to begin developing clear evidence-informed guidance for healthcare clinicians on the reduction or elimination of opioids for those who are prescribed them chronically.
National concerns about opioid abuse and opioid-related harm have driven regulatory, legislative, payer and pharmacy policies restricting opioid prescribing and, in many cases, calling for opioid discontinuation. State and national mandates to reduce opioid prescribing have, in turn, led to prescriber fears, opioid supply limitations and abandoned patients. While most practitioners agree that there is a need to decrease opioid use, few feel they have a clear understanding of how to get there. Further, there remains a need for clear guidance on how to safely discontinue opioid treatment in patients currently taking opioids. The consensus guideline produced over the next year by this panel will be intended to provide that guidance to pain specialists and primary care providers as well as to educate patients, payors, regulators and educations about the intricacies of opioid reduction.
Migraine Guideline Development
Migraine is a painful neurological disease associated with unilateral or bilateral pain or pulsing sensations. It is estimated that 36 million Americans live with migraines, yet less than 5% or those with the most debilitating for of migraine have sought help, received a diagnosis and or been treated.
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A consensus panel, with diverse expert perspectives on the medical, procedural, and complementary and integrative treatment of migraine, met in late 2018 to develop multidisciplinary guidelines for treating adults with frequent migraine.
CDC Guideline Consensus Panel
The AAPM Foundation convened a multidisciplinary panel of pain medicine experts, reflecting a spectrum of clinical, research, and academic experience, to develop practical recommendations for opioid prescribing in light of the 2016 "CDC Guideline for Prescribing Opioids for Chronic Pain," and other professional organization guidelines. That panel's "Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consensus Panel Report" was published in Pain Medicine. Read the Foundation's press release to learn more about this project.
Members of the multidisciplinary panel presented a spotlight session about their findings and recommendations during the AAPM 35th Annual Meeting in Denver on March 8, 2019. View a recording of the session.
Spine ERAS Protocol
A panel of experts and in spine surgery and anesthesia convened to develop an Enhanced Recover After Surgery (ERAS) protocol for spine surgery. The protocol is under development and expected to be ready for publication and sharing with appropriate institutions this year with a related educational webinar to follow.
Opioid-induced constipation (OIC) is the most prevalent type of opioid bowel dysfunction that results from the effects of the drugs on µ-opioid receptors expressed throughout the gastrointestinal tract.
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A panel of experts convened to develop and publish guidelines identifying assessment tools and outcome measures that are the most effective and practical for characterizing OIC severity, as well as corresponding objective thresholds that prompt the clinical decision to prescribe new OIC-specific prescription drug therapies.
The AAPM Foundation took a novel step in seeking grant funding from multiple industry partners to convene this consensus. The outcome of this work is cited in Pain Medicine while archived webinars developed using the consensus document as their underlying framework are offered in an on-demand format in the AAPM Education Center.
Urine Drug Monitoring
Urine drug monitoring (UDM) is used to detect the most commonly abused drugs. The Foundation provided the opportunity to educate and guide clinicians on the appropriate utilization of the most effective monitoring to support optimal patient care. Consensus Recommendations for Rational Urine Drug Monitoring in Patients Receiving Opioids for Chronic Pain, published in Pain Medicine will reflect the advances in the science, technology, practice, and practical uses of UDM in clinical care.
The use of methadone as an analgesic for severe chronic pain has expanded in recent years. It is effective for some patients, but has unique pharmacologic properties that call for caution and expertise in administering it. Methadone shows up in mortality reports with greater frequency than should be expected given the small number of prescriptions written in comparison with other opioids. Despite this evidence of risk, most states have designated methadone as a preferred analgesic, presumably because its low cost results in savings for publicly-funded health plans. The American Academy of Pain Medicine (AAPM) takes the position that methadone should not be designated as a preferred analgesic by any insurance payer, whether public or private, unless special medical education is provided. In taking this position, AAPM concurs with the Centers for Disease Control and Prevention (CDC) that methadone should not be considered a drug of first choice for chronic pain and should only be prescribed by health-care professionals experienced in its use who follow consensus, prescribing guidelines. Though methadone is invaluable in the treatment of heroin addiction and also belongs in the armamentarium of pain medications, specific medical education is necessary for prescribing and consuming it safely, and prescriber certification to do so should be considered.
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With a commitment to making high-impact, long-term change, a patient safety-focused, web-based continuing medical education (CME) program for all prescribers of opioids, with a targeted focus on those who prescribe methadone for the treatment of chronic pain was developed. The Methadone Education Curriculum is designed to equip prescribers with the knowledge, skills, and behaviors they need to implement evidence-based safe prescribing practices. Changes in prescribers’ knowledge, competence, and performance will minimize risks and reduce harm for patients being treated for chronic pain with methadone.
Goals of the curriculum
- Improve prescriber knowledge of methadone
- Implement risk reduction strategies and patient safety practices in prescribing methadone in both inpatient and outpatient settings
- Improve prescriber/patient interactions and patient adherence to proper use of methadone
- Improve patient safety and patient outcomes
The methadone education program is accessible in the AAPM Education Center.
Pain Awareness Emblem
The Pain Awareness Unity Circle emblem was developed with the assistance of numerous pain advocacy organizations to amplify the voices of pain patients, survivors, and caregivers as they work to increase patient access to research, treatment, and care through public awareness. The Unity Circle provides a visual tool to assist advocates in reaching the shared desired goal: a sustainable model for funding and provider resources.
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About the Emblem
During the summer of 2016, pain awareness advocates from around the country were invited to participate in focus group conversations to research the feasibility of conducting a nation-wide pain awareness initiative. These robust conversations lead to a determination that a clear shared interest and need exists among pain advocates to unify around a symbol that represents pain awareness and the shared vision of pain care as a human right. The Pain Awareness Unity Circle was developed to encapsulate the overarching themes, shared challenges, and aspirations of focus group participants.
The emblem is composed of three separate strands: research, treatment, and care. Multiple strands reflect the multiple efforts and voices of pain awareness advocates working to fulfill a common mission of providing pain patients with the respect and care they need. Though a simple shape, it is one that we believe will significantly resonate with a wide public audience, including millions of individuals suffering from severe pain and those who care and advocate for pain sufferers. Additionally, it is a design that lends itself well to being reproduced as a lapel pin and in other contexts.
Social Media & Hashtag
A wonderful place to express your support of this pain awareness initiative is on social media. Educate your personal social networks about the need to support pain patients and engage with the broader pain advocacy community on Twitter and Facebook using the hashtag #PainUnity. Engage with the American Academy of Pain Medicine on Facebook and Twitter social media at @AmerAcadPainMed.
Goals of Amplification
The overall goals in creating and sharing this symbol include:
- Increase overall public awareness and education about the millions of patients suffering from severe acute, chronic, and cancer pain.
- Encourage individuals who suffer from pain, treat patients in pain, or care for loved ones in pain to share their stories in order to raise awareness of this public health problem.
- Drive grassroots advocacy initiatives to raise the funding necessary to conduct research on pain treatments, especially within the context of the ongoing opioid addiction and abuse epidemic.
Download the Pain Awareness Unity Circle for use on your website, social media pages, or other marketing and promotion collateral.
Download theResource Guide for additional information about the emblem and its intended uses.
Pain Medicine Education Program (PMEP)
The AAPM Foundation Pain Medicine Education Program (PMEP) was designed to help industry representatives understand and appreciate the complexity of treating pain disorders and comprehend patients’ daily struggle with pain and its management. The program furthers representatives’ knowledge, confidence, and credibility when interacting with healthcare practitioners
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The content, derived from the highly successful Essential Tools for Treating the Patient in Pain™ and Opioid and Non-Opioid Medications Management programs, has been selected with sales, marketing, and medical affairs professionals in mind. The program covers subjects that are important to pain healthcare providers with whom industry representatives meet every day. Participants of this program receive unparalleled educational content that is developed and taught by recognized leaders in pain medicine and offers comprehensive, thorough, and nonbiased education.
Program graduates are granted use of an industry education emblem, which distinguishes those who have completed the PMEP. The emblem may be used on business cards.
Depomed, Inc. was the inaugural AAPM Foundation PMEP industry partner. More than 350 Depomed employees participated in the training series; you can identify learners by looking for the PMEP emblem on representatives’ business cards.
“We are excited to be working with Depomed as the company helps support the AAPM Foundation’s commitment to furthering the knowledge exchange among the scientific, clinical and other professionals working within the pain community,” said Charles Argoff, MD, AAPM Foundation Board President.
Daiichi Sankyo, Inc. will launch the PMEP training series for 300 Daiichi Sankyo employees in 2018.
This educational series for industry professionals sets a new standard for industry representatives.
Essential Tools for Treating the Patient in Pain™
Designed to enhance clinician skills, the Essential Tools for Treating the Patient in PainTM live and online courses are designed for healthcare clinicians who seek to gain critical fundamental tools from the leading authorities in pain medicine. Evidence-based practices, practical approaches, and clinical pearls for the treatment of common pain disorders address unmet educational needs and encourage dialogue. Clinically focused, case-based lectures designed to advance patient outcomes help clinicians improve the assessment, diagnosis, and treatment of patients with various acute, cancer, end-of-life, and chronic pain syndromes.
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The Essentials™ program aims to help clinicians
- evaluate patients and develop appropriate treatment plans
- describe pharmacological, interventional, rehabilitation, and advanced techniques for the treatment of chronic pain
- implement evidence-based protocols for appropriate opioid-prescribing practices
- articulate the distinction between drug misuse, dependence, and addiction
- understand the legal issues surrounding pain management
- identify the various screening tools and patient communication techniques
- improve quality of and access to pain care to meet the needs and demands of the escalating pain populations.
Early Investigator Research
The burden of pain in the United States is astounding with more than 100 million Americans suffering from pain that persists for weeks to years. The financial toll of this epidemic costs more than $600 billion a year-- only 1% of NIH research funding is dedicated to pain research, and it isn’t enough. The AAPM Early Investigator Research Grant was established in 2019 to offer financial support of preliminary or pilot research projects relevant to a comprehensive, multidisciplinary, patient-centered approach to pain management.
Pain Medicine Fellowship Scholarship Program
The Pain Medicine Fellowship Scholarship Program is designed to award Pain Fellows currently in accredited ACGME or AOA Pain Medicine Fellowship Programs on funding a scholarship for attendance to the Essentials for Treating the Patient in Pain™ program and a one-year membership to AAPM.
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The objective of the program is to:
- Invite Pain Medicine Fellows to attend the Essentials for Treating the Patient in Pain™ program and receive a one-year AAPM membership
- Expand Fellows’ educational exposure in pain medicine
- Introduce Pain Medicine Fellows to AAPM thought leaders and researchers
- Provide exclusive AAPM networking opportunities
The AAPM Acute Pain Initiative was conceived by the Acute Pain Medicine shared interest group. During the next several months, the idea took shape around an action plan to establish research and educational objectives to help define the subspecialty of acute pain medicine.
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A multidisciplinary panel met to identify gaps and set priorities in acute pain medicine research and education. Identified were three areas of critical need:
- creation of an open-source acute pain data registry and support tool to inform clinical decision making and resource allocation and to enhance research efforts
- establishment of a strong professional acute pain medicine identity as an accredited subspecialty
- development of educational goals targeted toward third-party payers, hospital administrators, and other key stakeholders to convey the importance of acute pain medicine.
In addition, the panel prepared a seminal publication on acute pain medicine, Acute Pain Medicine in the United States: A Status Report, and submitted it to AAPM's journal, Pain Medicine, for publication.
The goal of the initiative is to improve the delivery of acute pain care and enhance the quality of patient recovery after surgery, illness, or trauma. The extended goal is to reduce the incidence of transition from acute pain into the debilitating disease of chronic pain.
Primary Care Summit
In keeping with the recommendations of the Institute of Medicine's (IOM) report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, AAPM organized and convened the Primary Care Summit. One of the report's recommendations called for collaboration among healthcare providers to address gaps in access to quality pain management. Recognizing the critical role of the primary care clinician community, AAPM convened two meetings of the Summit participants.
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The Summit meetings (phases 1 and 2) focused on education—the topic was identified through a series of interviews conducted with representatives of the participating organizations. Specific areas addressed within the education domain include the following:
- delivery systems
- outcomes and impacts
- program sustainability.
After completing work on the agreed-upon performance requirements for each of the five areas of education, the Summit participants reconvened for phase 3 with the following objectives:
- Develop action plans that the organizations can advance collectively.
- Develop a consensus paper detailing plans to address the gaps in pain medicine education.
AAPM recognizes the importance of continuing to devote resources to the activities of the Primary Care Summit in the coming years.
American Academy of Family Physicians
American Academy of Pain Medicine
American Academy of Physician Assistants
American Association of Nurse Practitioners
American College of Osteopathic Family Physicians
American College of Physicians
American Medical Association
American Osteopathic Association