OHA’s neck pain guidelines may be revised.

By Elizabeth Hayes

Staff Reporter, Portland Business Journal

May 10, 2019, 1:40pm PDT

Oregon health officials are rethinking their approach to chronic pain coverage and mandatory tapering off of opioids for Medicaid patients.

The Oregon Health Authority on Friday announced two major developments in a saga that has left patient advocates up in arms. The first is that the Health Evidence Review Commission will reconsider the coverage guidelines related to neck and back pain that went into effect in 2016.

Secondly, OHA staff is offering a revised proposal to the commission that would make fibromyalgia eligible for opioid therapy, along with four other chronic pain conditions. The commission will consider those options on May 16th.

OHA Chief Medical Officer Dr. Dana Hargunani said new evidence regarding opioid therapy and opioid tapering emerged over the past year in the course of crafting the chronic pain guidelines. Part of the challenge is actually the lack of hard evidence, she said.

“We realized we need to go back and revisit the back pain guidelines to make sure we understand the evidence,” Hargunani said. “One of the takeaways is the overall evidence of effectiveness of chronic pain treatment with opioids is sparse.”

The current back and neck pain guidelines were intended to help patients manage their pain with less reliance on medication and fewer surgeries. OHA began covering alternative treatments, such as acupuncture and osteopathic manipulation, with a one-year tapering time frame for opioids.

“The evidence we’re reviewing now doesn’t support some parameters around opioid tapering,” Hargunani said.

In 2017, the commission convened the Chronic Pain Task Force to explore whether a similar model should be offered for patients with five other chronic pain conditions that are not currently covered: chronic pain due to trauma; post-procedural chronic pain; chronic pain syndrome; other chronic pain and fibromyalgia.

At first, the proposed policy included the 12-month forced taper. After pain advocates raised alarms, the task force softened the tapering requirement by not including a specific timeframe or dosage level, but individualized plans.

Then OHA ordered a third-party review of evidence by Washington-based Aggregate Analytics Inc. to evaluate how closely the proposal aligned with available evidence.

The proposal now before the commission will add non-opioid therapies for the five conditions, as well as opioid therapy for fibromyalgia, which wasn’t part of the earlier proposal.

“We’ve learned a lot, both about the evidence and the experience of individuals living with chronic pain in Oregon,” Hargunani said. “We appreciate the input we’ve received from experts and individuals, and it’s helped us improve coverage for five conditions.”

Wendy Sinclair, co-founder of the Oregon Pain Action group and a chronic pain patient, said she was encouraged that OHA and HERC are reopening the back and spine policy on mandatory opioid tapers to zero.

“We are hopeful that a revised policy will be adopted that promotes appropriate medical treatment, based on the individual need and the best available treatment, as discovered through a sound doctor-patient relationship,” she said.



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