Managed Care


Pain Management

Pain Management

Moving an injured limb as soon as possible helps prevent complex regional pain syndrome (CRPS), a problem that causes pain with movement, allodynia, and edema in the injured extremity, according to a study in the Journal of Pain

Cancer pain treatment should be tailored to individual patients, according to a presentation at the 7th World Congress of the World Institute of Pain. A holistic view of pain under such circumstances would take into account variations in intensity, and help create coping mechanisms, presenters argued. 

A program relying in part on patient education, fluid management, and decreasing the length of incisions, not only helped patients recover faster from elective colon and rectal resection, but also drastically cut down on their use of patient-controlled opioid analgesia. That decreased from 63.2% to 15% of patients, according to researchers as Oregon Health and Science University. 

Policies states adopt can do a lot to address pain management, according to researchers at the University of Wisconsin. They examined laws to determined what sort of language best supports pain management as a part of public policy.  “Patients with pain may receive pharmaceutical and non-pharmaceutical treatments, depending on the diagnosis, but opioid analgesics are not always needed. However, opioid analgesics remain a very important treatment option, yet are sometimes difficult to obtain when clinically warranted.”

Corticosteroid injections and physical therapy work about equally well on shoulder impingement syndrome, a persistent pain from a variety of causes of shoulder inflammation, such as tendonitis, bursitis, according to a study in the Annals of Internal Medicine. Injections are usually less costly than therapy, if they don’t necessitate further care down the road.

More should be invested in the diagnosis and treatment of pediatric chronic pain, according to a study in the Journal of Pain. “Total costs to society for adolescents with moderate to severe chronic pain were extrapolated to $19.5 billion annually in the United States,” the study states.

Just how self-efficient a person is will affect the level of pain he feels, according to a study in the Journal of Pain. Researchers found “significant overall associations with impairment, affective distress, and pain severity….”

There’s nothing fundamentally wrong with morphine but, according Salimah H. Meghani, MD, one of the authors of a study tracking the drug’s use, morphine “has clinically relevant metabolites that may accumulate in the body in the presence of renal disease and cause patients to experience more side effects.” 

A study in the journal Arthritis Research and Therapy makes just that point. It says that the therapy moxibustion improved function and relieved pain for up to 18 weeks for patients suffering from osteoarthritis of the knee.

Patients with chronic musculoskeletal pain found relief through telemonitoring, according to a study in JAMA. Telemedicine intervention helped reduce pain by 30%, and patients guided in this manner also reported greater satisfaction with their care and the medications they were prescribed.

Opioids such as Vicodin and OxyContin are prescribed most often in Southern states such Alabama and Tennessee, than in the rest of the nation, according to data from the Centers for Disease Control and Prevention. Officials want to see better monitoring of painkillers, which can lead to addiction if taken without following the guidelines.

The venom in a marine cone snail contains peptides that immobilize anyone unlucky enough to get stung. However, that venom might also be the key to managing neuropathic pain, according to researchers in Australia.

Or maybe not, say authors of a study that argues that things like temperature, humidity, or precipitation do not increase lower back pain. Wind speed might have some effect, according to the study in the journal Arthritis Care & Research

Morphine and oxycodone are both used to deal with pain in cancer patients. But which works best? A study in the Journal of Pain and Symptom Management concludes that there is “no difference between analgesic response or adverse reactions to oral morphine and oxycodone when used as first- or second-line opioid. These data provide evidence to support opioid switching to improve outcomes.”

About 2 million people are addicted to heroin or opioid analgesics and, according to a recent study in JAMA Internal Medicine, 80% are not in treatment. Hospitals are devising methods to address this problem. 

Cover Story
Insurers have not focused much on chronic pain. They should. It presents a humanitarian and business opportunity.

Chronic pain is the black hole of medicine, wrenching energy from healing and drawing patients and physicians into a vortex of recrimination and paralyzing self-doubt. Ignorance, prejudice, grievance, fear, failure — troubles swirl around the chronic pain patient.

So most patients go undertreated for pain. They certainly aren't helped by their health plans. Most plans don't even identify their chronic pain patients, at least not until the dollars reach a critical mass, and then plans have little idea what to do.

Medication Management
Although effective treatments are available, helping patients cope is a minefield of administrative and legal barriers

The World Health Organization states that 85 to 90 percent of cancer pain can be controlled with drugs, but according to a study by the Institute of Medicine, “for many Americans with cancer, there is a wide gulf between what could be construed as the ideal and the reality of their experience” in the treatment of pain.

News & Commentary

Physicians increasingly ignore clinical guidelines for treating back pain, causing skyrocketing costs with approaches that put patients at risk from unnecessary surgery, overuse of narcotics, and other problems, according to a study in JAMA Internal Medicine.

Employers believe in this hybrid approach. Is it time for medical insurers to look at it carefully?

Combining state-of-the-art mainstream medicine with a range of less-traditional but evidence-based therapies is becoming an accepted, cost-effective option for improving patients’ health. The blended approach is referred to as integrative medicine.

Increasingly, integrative techniques that have been validated by solid scientific research are being used to ease pain.

Capital Health Plan achieved a 79% improvement in pain scores and a 54% improvement in function scores for its members

Twenty-five billion dollars is spent each year on the medical care of back pain, and $50 billion is lost in productivity. Primary care physicians might have difficulty providing thorough counseling and treatment to their patients about the condition.