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NEW RESOURCES AVAILABLE FOR COMPARING OSTEOARTHRITIS PAIN MEDICATIONS

The U.S. Agency for Healthcare Research and Quality (AHRQ) has released new clinician and consumer summaries and continuing medical education activities in support of a recent updated research report comparing the effectiveness and safety of analgesics in the treatment of osteoarthritis. Overall, the report found no clear differences in the effectiveness of different nonsteroidal anti-inflammatory drugs, but did find potentially important differences in the risk of serious harms. The updated report, entitled “Analgesics for Osteoarthritis—An Update of the 2006 Comparative Effectiveness Review,” includes new research that better addresses the comparative effectiveness and safety of oral and topical medications. These and many other evidence-based decision making resources are available on AHRQ's Effective Health Care Program Web site: www. effectivehealthcare.ahrq.gov.

PREGABALIN APPROVED FOR SPINAL CORD INJURY PAIN

In June, the FDA approved adding use in treatment of spinal cord injury to the indications for the neuropathic pain drug pregabalin (Lyrica). This makes pregabalin the first FDA-approved treatment for neuropathic pain from spinal cord injury. Pregabalin was previously approved by the agency for painful diabetic neuropathy, postherpetic neuralgia, fibromyalgia, and partial-onset seizures in epileptic adults taking one or more seizure drugs. The new indication was based on two randomized, double-blind, flexibly dosed, placebo-controlled phase III studies. A combined total of 357 patients received 150 to 600 mg of pregabalin daily and were allowed to take other pain medications during the trial, including NSAIDs, opioids, and nonopioids. One trial enrolled traumatic spinal cord injury patients; the other included a mix of traumatic and nontraumatic injury patients. Pregabalin significantly reduced neuropathic pain from the spinal cord injuries versus placebo over the study periods of 12 and 16 weeks and it produced a 30% to 50% reduction in pain compared with those taking placebo.

HEALTH CARE REFORMS WILL CHANGE HOW PAIN IS ASSESSED AND TREATED

In an American Pain Society Annual Scientific meeting keynote address on May 17, Daniel Carr, MD, of Tufts University addressed how pain care will be influenced by anticipated reforms in the U.S. health care system. Carr asserted that current models of health care delivery offer both obstacles and opportunities for achieving quality and effectiveness in pain-related care.

“Recent triumphs in biomedical science have extended lifespan, but the futility and unsustainable cost of treating advanced disease have brought health care back full circle to its ancient roots with interventions intended primarily to reduce symptoms,” said Carr. “Today we are in the midst of a disjointed and politically volatile reshaping of the American health care system, and chronic pain is by far one of the most prevalent and costly conditions that has to be addressed.”

Carr explained that the preferred approaches to pain care delivery are evidence-guided, sensitive to individual variability, and are focused on quality and achieving favorable outcomes. In the future, Carr believes, health care professionals committed to pain management will find that it's advantageous to be aligned with the priorities of accountable care organizations (ACOs), such as avoiding hospitalizations and other measures of quality and cost-effectiveness. An ACO is a group of health care providers that agrees to link reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.

The ACO model rewards prevention, early detection, and interprofessional, team-based management in low-cost settings such as primary care practices. “Although this model is perceived as threatening, it is the very same public health approach that leaders in the pain community have long advocated,” said Carr. “When working properly, ACOs untether fees from services, encourage time to be allocated for complex patients, and support use of less invasive and behavioral therapies.

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In June 2011, the Institute of Medicine submitted to Congress its long-awaited report, “Relieving Pain in America: A Blueprint for Transforming Prevention, Treatment, and Research,” which made recommendations for improvements in pain care, education, and informing policymakers and public and private funders of health care that pain is a major national public health problem that must be addressed with aggressive action. The broad task for the IOM Pain Committee was to study the current state of pain research, patient care and education, and explore new approaches to help advance the field. It is the first comprehensive, high-level government look at pain as a prominent public health problem in the United States.

“The key contribution of the IOM report is its endorsement of a broad public health approach to pain care. Pain is being recognized as a public health concern because it is very costly and impacts a large population, so our health care system needs to promote multi-faceted, community-based care for pain rather than relying on a limited number of pain specialists,” Carr said. He explained that the public health approach involves defining a health problem, identifying its risk factors, adopting community-based intervention models to improve health outcomes in the target population, and monitoring effectiveness.

“The upbeat news for the pain care community is that the intent of the Affordable Care Act is to focus on population-based health management, which for pain care means addressing the complex, multifaceted components of chronic pain. This public health approach strongly favors community-based, multidisciplinary pain care that not only seeks to deliver pain relief but also avoid hospitalizations and improve overall functioning and quality of life,” Carr said.

“I am optimistic about the future of pain management in an ACO model that eliminates unnecessary cost and seeks to improve populations-based outcomes. Its advantages for pain care make this an exciting time for adaptive, collaborative professionals seeking to treat pain within a patients-centered, public health approach,” Carr concluded.

CMS AWARDS HOSPICE-PALLIATIVE CARE-RELATED INNOVATION GRANTS

The U.S. Centers for Medicare and Medicaid Services (CMS) awarded four hospice or palliative care providers 3-year Health Care Innovation grants, designed to implement projects that aim to deliver better health, improved care, and lower costs to people enrolled in Medicare, Medicaid, and the Children's Health Insurance Program, especially for those with the highest health needs. Palliative Care Consultants of Santa Barbara, California, received $4.2 million to provide health care services to the frail elderly in times of crisis, with a goal of reducing emergency room visits. The estimated 3-year savings is $3.2 million. Suttercare Corp. of California received $13 million to expand its Advanced Illness Management program across the entire Sutter Health system in northern California. Through a complex medical home model, it will serve chronically ill patients in clinical, functional, or nutritional decline not ready for hospice care. Anticipated 3-year cost savings is $29.3 million. The Trustees of the University of Pennsylvania in Philadelphia also received a grant, for $5.3 million, to care for patients with advanced cancer and substantial palliative care needs yet not eligible for hospice. Expected savings is $9.4 million. The University of Alabama at Birmingham received $15 million to extend a regional network of lay health workers to expand cancer support services. It expects to save $49.8 million.

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.