Needed: More Support for Chronic-Pain Treatment

Survey Results ( Click Here )

SALT LAKE CITY _ The No. 1 problem facing doctors and others who treat chronic pain is the lack of support from third-party payers such as insurance companies. This according to a survey of 38 medical professionals who attended the Sept. 27 inaugural membership meeting of the Utah Academy of Pain Medicine. (click here to see complete survey results).

Limited benefits and barriers to reimbursement are among the problems cited by 26 respondents asked to name the primary blocks to good chronic-pain care in Utah. Primary care physicians also were singled out by 11 respondents as lacking education and harboring misconceptions about the treatment of chronic pain.

If the survey results can be believed, the quality of chronic-pain care in Utah leaves plenty of room for improvement. Most respondents (26) say the overall is fair, eight believe it is good and two say it's poor. Not a single vote went into the "excellent" column.

"Needs help," was the succinct summation of one respondent, asked to characterize the state of pain medicine in the state of Utah.

The professionals surveyed believe patients without medical insurance face an uphill climb to find treatment. A majority of respondents said treatment is either difficult to obtain (28) or not obtainable (6) for patients lacking insurance. Only three respondents said uninsured patients should find it somewhat easy to find treatment.

Of the barriers created by third-party payers, unwillingness to fund pain treatments topped the list as the most frequent barrier with 12 responses. Problems with pre-authorization followed with nine mentions. Other frequent complaints were of limited benefits (seven), refusal to pay for services (five), limits on prescribing (four) and excessive paperwork (four).

Medicaid was judged the most cumbersome payer with 100% of respondents reporting problems either frequently (24) or sometimes (11). Intermountain Health Care and Workers Compensation were next with voters as creators of barriers.

Among treatment modalities, behavioral therapy gets little support from payers with 33 respondents reporting trouble obtaining payer authorization either frequently or sometimes.

When it comes to clinicians' top concern in the prescribing of opioids, clinicians split their votes equally between contributing to abuse/addiction (12) and experiencing trouble with patient side effects (12). Despite the spate of publicity devoted to high-profile cases of doctor prosecution, regulatory issues, with only three mentions, do not appear to worry Utah doctors much. At least one respondent cited a favorable regulatory environment as a plus of practicing in Utah.

The news is not all bleak. Nine respondents praised the availability of quality clinics, particularly in Salt Lake. Other voters lauded the insurance companies and primary care physicians in the state who support quality pain management.

Yet the professionals who completed this survey see a need to increase the number of pain providers in the state, listing it as a top concern they would like addressed. Reducing limits on benefits, expanding the treatments available and educating physicians and pharmacists were also seen as among the most vital steps to take.

Several respondents expressed the need for more communication among members of the pain specialty and for educational outreach to potential patients and the public.

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