Chronic pain is the #1 reason people seek care, the most common chronic condition, the #1 cost driver of health care, and #1 cause of addiction and disability. The National Health Interview Survey (NHIS) found that 126 million adults (55.7%) experienced a pain condition in the past year with 20.1% having daily pain and 31.8% experiencing severe pain. In the United States, chronic pain accounts for over $600 billion in healthcare costs. When the pain condition becomes chronic, it is associated with depression, missed work, disability, and intensive use of high-cost high-risk interventions including opioid analgesics, multiple medications, and surgery. According to the Centers for Disease Control (CDC), there was over 700,000 deaths from opioid overdoses from 2000-2020, with a dramatic increase during the COVID-19 crisis. Many deaths involved individuals under the age of 40 years and began with prescription opioids for pain conditions.
These problems exist because over 50% of the people with pain conditions continue to have pain 5 years later despite treatment because patient-centered risk factors that cause chronic persistent pain and are not addressed in routine care. Thus, the National Institute of Medicine (NAM) states that health professionals' primary role for pain conditions should be guiding, coaching, and assisting patients with day-to-day self-care to reduce these risk factors. However, this is rarely done as health providers lack the time, training, tools, and reimbursement to guide patients in self-care. Primary care providers do not have time in their abbreviated visits to provide patient-centered training while pain specialists increasingly offer lucrative interventions such as spinal cord stimulators, Intrathecal pain pumps, radiofrequency ablation, injections, nerve blocks, and pain-numbing medications such as opioids.
The Solution: The Personalized Activated Care and Training (PACT) program was developed and tested with funding from the National Institutes of Health to provide doctors with a simple reimburseable strategy to implement self-management training of patients with safe non-addicting treatments. Like other chronic conditions such as diabetes and heart disease, care for pain conditions needs to include patient-centered training and support to reduce the lifestyle causes of pain as part of the transformative care model. Both diabetes educators and cardiac rehabilitation services are included in routine care. PACT introduces a transformative solution into routine pain care by integrating a system for patient engagement, training, and health coaching into standard protocols for care. PACT addresses a major gap in healthcare by providing a patient-centered tool for helping them manage pain conditions that is easy to use by patients, is reimbursed by health plans, requires minimal time to implement, leverages telehealth coaching and digital technology to train and supports patients in day-to-day self-care. PACT allows the provider to write a prescription for self-management training instead of opioids for pain conditions that has better long-term outcomes to reduce addiction. We are in the process of broad-scale implementaiton of PACT to help the health care system recover from its formidable cost escalation and devastating opioid crisis. We are happy to share our experiences as part of the HEAL initiative.