Articles related to PAIN MANAGEMENT

CMS released its new, updated, and deleted codes specific to Medicare payers at the end of 2022. The document also highlights payment information that will impact practices providing care to Medicare beneficiaries in 2023.

The update was based on the findings of 31 systematic reviews and 16 randomized controlled trials (RCTs) chosen from a total of 820 publications. The investigators set out to answer seven questions:

In the US, chronic pain is widespread and continues to be a burden for people, families, and society as a whole. Extreme caution should be exercised when choosing to take an opioid to treat pain. The organizations do not advocate the regular use of opiate analgesics to treat chronic pain, as the hazards to the patient outweigh the minimal benefits that opioids may offer. Buprenorphine should be taken into consideration if it is decided to employ long-term opioid therapy for a patient due to its lower risk profile. By checking for underlying mental problems and a history of traumatic brain injury, clinicians can further lower the risk. Although risk mitigation strategies have been used to reduce risk in opioid patients, the guideline development group was surprised to find little evidence in this area.

A 12-month controlled trial randomized 189 individuals to spend 70–90 minutes performing 11 exercises or 20–30 minutes performing 5 exercises for 3 months. Outcomes were measured biweekly for the intervention period and again at 6 and 12 months. The two approaches were similar, except for one outcome. In the Knee Injury and Osteoarthritis Outcome Score for function in sports and recreation, high-dose therapy was superior.

Christen Fuller, MD, describes her approach to the often-conflicted situation. One of her keys? “Know your own limitations.” Another? Don’t let the frequency of the patient coming in for pain management lead you into defensiveness and minimizing their pain.

In an analysis of 26 reviews covering 8 antidepressant classes and 22 pain conditions, no review provided a high level of evidence for the effectiveness of antidepressants for chronic pain. The strongest evidence may be for SNRIs for back pain, postoperative pain, neuropathic pain, and fibromyalgia.