Help Employees Manage Pain
As is true for the treatment of substance use disorders, treating pain requires an individualized, multidisciplinary, and multi-modal approach. Employers should aim to include a broad spectrum of pain treatment modalities in their health plan and take special care not to create or support barriers to their use. Coverage limitations, cost-sharing requirements, utilization management, and network adequacy for these benefits should be considered. Employers should consider weighing these variables against how opioids are covered to understand how and why opioids may have historically been prescribed more prevalently than these alternatives. Special attention should be paid to both medical and dental plans.
Many pain management modalities have been proven to provide the same or better pain relief benefits as opioids without the associated risks, excluding some specific clinical conditions. Health plan coverage of these treatments can help prevent OUD and opioid related consequences by reducing the likelihood of an initial exposure to prescription opioids. In some instances, health plan members are constrained by what their health plan will cover as opioids have historically been less expensive than other pain management treatment such as physical therapy.
Although there are numerous risks associated with opioids, there are some situations where they are necessary For instance, opioids may be appropriate when used for cancer and end-of life patients among other conditions. Comprehensive pain assessment, management, and prescribing techniques are largely a responsibility of health care providers. However, employers can design their benefits to not incent opioid prescribing and to provide coverage of non-opioid options.
Despite most dental pain being acute in nature and manageable with non-opioid analgesics, dentists are among the top prescribers of opioids in the U.S. This is particularly true among adolescents ages 10-19. A 2019 study in the Journal of the American Medical Association found that dentistry accounts for approximately 25% of first-time opioid prescriptions in this population. Exposure to opioids earlier in life is associated with an increased risk of opioid misuse and opioid use disorder.
Pain management modalities to consider for health plan coverage include:
Acetaminophen, NSAIDS, Select anticonvulsants and antidepressants, Musculoskeletal agents, Antianxiety medications, Topical agents, Opioids
Physical/occupational therapy, Chiropractic care, Transcutaneous electric nerve stimulation (TENS), Massage therapy, Traction, Therapeutic ultrasound
Complementary and Integrative Health
Acupuncture, Massage and manipulative therapies, Mind-body exercise (ex. yoga, tai chi)
Local anesthetics (Peripheral nerve injections, Sympathetic nerve blocks, Facet joint nerve block and denervation injection, Trigger points) , Steroid injections (Epidural injections, Joint injections), Medication pumps, Radiofrequency ablation, Neuromodulation, Cryoneuroablation, Vertebral augmentation, Regenerative and stem cell-based therapies, Interspinous process spacer devices
Behavioral Health Approaches
Cognitive behavioral therapy (CBT), Acceptance and commitment therapy (ACT), Mindfulness-based stress reduction (MBSR), Self-regulatory or psychophysiological approaches
Pain Management Innovation
There are other promising practices for pain management. However, they are not always considered evidence-based by health plan standards. Consequently, they may not always be readily available for addition to health plan coverage. Employers should stay up to date on innovative technologies in this area and initiate regular conversations with their heath plans regarding their support of these innovations.