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.
1National 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.
2Dahlhamer, 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. Retrieved from: http://dx.doi.org/10.15585/mmwr.mm6736a2.
3Lauer, 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. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/30594480/.
4Kennedy, 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.
5Centers 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.
6Centers 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.
7Williamson, 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.