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The Pain Management Best Practices Inter-Agency Task Force was established to propose updates to best practices and issue recommendations that address gaps or inconsistencies for managing chronic and acute pain. The U.S. Department of Health and Human Services is overseeing this effort with the U.S. Department of Veterans Affairs and U.S. Department of Defense.

The Task Force has now just published its Final 116 Page Report.

50 million adults in the United States have chronic daily pain, with 19.6 million adults experiencing high-impact chronic pain that interferes with daily life or work activities. However, the Task Force emphasizes the importance of individualized patient-centered care in the diagnosis and treatment of acute and chronic pain.

This report is therefore “broad and deep and will have sections that are relevant to different groups of stakeholders regarding best practices.” It emphasizes the development of an effective pain treatment plan after proper evaluation to establish a diagnosis, with measurable outcomes that focus on improvements, including quality of life (QOL), improved functionality, and activities of daily living (ADLs).

A multidisciplinary approach for chronic pain across various disciplines, using one or more treatment modalities, is encouraged when clinically indicated to improve outcomes. These include the following five broad treatment categories, which have been reviewed with an identification of gaps/inconsistencies and recommendations for best practices:

Medications: Various classes of medications, including non-opioids and opioids, should be considered for use. The choice of medication should be based on the pain diagnosis, the mechanisms of pain, and related co-morbidities following a thorough history, physical exam, other relevant diagnostic procedures and a risk-benefit assessment that demonstrates that the benefits of a medication outweigh the risks. The goal is to limit adverse outcomes while ensuring that patients have access to medication-based treatment that can enable a better QOL and function. Ensuring safe medication storage and appropriate disposal of excess medications is important to ensure best clinical outcomes and to protect the public health.
Restorative Therapies, including those implemented by physical therapists and occupational therapists (e.g., physiotherapy, therapeutic exercise, and other movement modalities) are valuable components of multidisciplinary, multimodal acute and chronic pain care.
Interventional Approaches, including image-guided and minimally invasive procedures, are available as diagnostic and therapeutic treatment modalities for acute, acute on chronic, and chronic pain when clinically indicated. A list of various types of procedures, including trigger point injections, radio-frequency ablation, cryo-neuroablation, neuromodulation, and other procedures are reviewed.
Behavioral Approaches for psychological, cognitive, emotional, behavioral, and social aspects of pain can have a significant impact on treatment outcomes. Patients with pain and behavioral health comorbidities face challenges that can exacerbate painful conditions as well as function, QOL, and ADLs.
Complementary and Integrative Health, including treatment modalities such as acupuncture, massage, movement therapies (e.g., yoga, tai chi), and spirituality, should be considered when clinically indicated.

Continued medical and scientific research is critical to understanding the mechanisms underlying the transition from acute to chronic pain; to translating promising scientific advances into new and effective diagnostic, preventive and therapeutic approaches for patients; and to implementing these approaches effectively in health systems.