Multimodal Pain Management: Considerations for Clinicians Treating Pain

Chronic pain is rising due to higher incidence of associated conditions within a larger aging population.[1] Individuals dually eligible for Medicare and Medicaid in particular have higher levels of chronic pain, and use prescription opioids to treat pain at a higher rate compared to Medicare-only beneficiaries, thus placing them at a higher risk for opioid misuse or addiction.[2],[3],[4],[5],[6] The Centers for Disease Control and Prevention suggests providers use a multimodal approach to pain management that offers individuals access to a range of therapy options, which will help determine the most effective combination of services that improves their pain-related function and quality of life.[7]

This brief presents examples of multimodal pain management options that clinicians can consider for treating pain among dually eligible individuals, including key evidence and considerations for prescribing each modality.

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References
[1] National Institutes of Health. (n.d.) The Role of Opioids in the Treatment of Chronic Pain. Retrieved from: https://prevention.nih.gov/research-priorities/research-needs-and-gaps/pathways-prevention/role-opioids-treatment-chronic-pain
[2] Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., … Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults. Morbidity and Mortality Weekly Report, 67, 1001-1006. http://dx.doi.org/10.15585/mmwr.mm6736a2
[3] Lauer, E., Henly, M., & Brucker, D. (2018). Prescription opioid behaviors among adults with and without disabilities – United States, 2015–2016. Disability and Health Journal, 12. 10.1016/j.dhjo.2018.12.001.
[4] Kennedy, J., Burley, M., & Roll, R. (2018). The prevalence and treatment of opioid misuse among working-age adults with disabilities, 2016. Retrieved from: https://static1.squarespace.com/static/5abe7e9b5ffd206d61d648ef/t/5af4765b1ae6cf375890b0d3/1525970524389/opioid_misuse_and_abuse.pdf
[5] Centers for Medicare and Medicaid Services Medicare and Medicaid Coordination Office. (2018) Data Analysis Brief: National Trends in High-dose Chronic Opioid Utilization among Dually Eligible and Medicare-only Beneficiaries (2006-2015). Retrieved from: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/Downloads/OpioidsDataBrief_2006-2015_10242018.pdf
[6] Centers for Medicare and Medicaid Services Medicare and Medicaid Coordination Office. (2016) Opportunities for MMPs, PACE organizations, and D-SNPs to Prevent Identify, and Treat Opioid Addiction or Misuse among Medicare-Medicaid Dually Eligible Beneficiaries. Retrieved from: https://www.integratedcareresourcecenter.com/pdfs/HPMS_MMP-opioid_overutilization_10_3_16%20508%20clear.pdf
[7] Williamson, K., Alikhan, S., Greene, K., Becker, M., & Tewarson, H. (2020). Expanding access to non-opioid management of chronic pain: Considerations for governors. Washington, DC: National Governors Association Center for Best Practices. Retrieved from: 

https://www.nga.org/wp-content/uploads/2020/08/NGA_PainManagement.pdf

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