Multidisciplinary Pain Care Difficult to Access, Report Says

According to a national survey of patients with chronic pain, cost is one of several barriers to accessing multidisciplinary treatment, and many patients would like a wider choice of specialists and therapies.

The US Pain Foundation said they released the survey in honor of September as Pain Awareness Month. The number of Americans living with chronic noncancer pain is thought to be about 100 million, according to one estimate. In this survey, nearly 75% said they had been living with the pain for at least 10 years and one-third said the pain had been chronic for more than 20 years.

The survey was conducted between August 4-13, 2020, in all 50 states and the District of Columbia.

Most respondents had musculoskeletal (80.9%) or neurological conditions (69.7%) that created the pain, followed by rheumatological (52.8%) or gastrointestinal (26.8%) conditions. Most respondents were female (81.7%) and most were White (85.2%). By age, most were in the 55-64 age bracket (35.1%), followed by 45-54 years (26.2%).

The majority of the 1581 respondents answering the survey had some form of insurance, including employer-sponsored insurance through work (31.6%); Medicare and private insurance (27.8%); Medicare alone (20%); Medicaid (12.3%); and insurance through the Affordable Care Act (4.4%). Just 4% reported having no insurance.

The report said some takeaways raised by the results are:

Cost as a barrier to access: 76.5% said cost prevented them from receiving one or more treatment options, including massage (52.8%), acupuncture (39%), physical therapy (29.4%), chiropractic care (27%), exercise programs (26.8%), and medical cannabis (24.4%). More than half of those in the survey said high insurance copays prevented them from receiving treatment.

A lack of access to multidisciplinary specialists and alternative therapies: More than 75% of respondents said that at their pain clinics, psychologists, nutritionists, physical therapists and sleep specialists were not available. Providers, usually pain specialists, emphasized medications (38.4%) and interventional procedures (26.2%), while 39% of patients said they were hoping for more emphasis on complementary and integrative health. The specialist most sought after by patients are massage therapists (48.4%) but most (52.8%) said cost prevented them from accessing therapy.

Telehealth is a boon for patients in pain: Since 50.7% of patients reported mobility issues, the US Pain Foundation called the telehealth changes wrought by the coronavirus disease 2019 pandemic is a “huge silver lining.” Nearly 90% of patients want telehealth to continue.

Most patients use heat and cold therapy: 77.3% of respondents called it “somewhat effective” or “effective”. Heat was used at least once a week by 67.8% of respondents and nearly 45% used cold therapy.

After heat and cold therapy, a wide range of 34 other treatments, techniques, and strategies were cited by patients seeking relief, including prescription opioids (58.1%), prescription nonopioids (54.3%, and OTC medications (46.7%).

Besides cost, other barriers to access, for those who had insurance, were prior authorization requirements and annual visit limits (as for physical therapy). Those living in rural areas also had problems accessing multidisciplinary care.

Multidisciplinary care typically encompasses a range of specialists (ie, pain, neurology, psychology, physiotherapists, occupational therapists, psychotherapists, social workers) and nondrug therapies in addition to or in place of pharmaceutical and surgical interventions, such as exercise, physiotherapy, counseling, cognitive-behavioral interventions, self-help strategies, and the acquisition of pain management skills.