Poster Number-33 - Clinical Value and Utilization of Pharmacologic, Nonpharmacologic and Self-Healing Therapies: A Pilot Study

Clinical Value and Utilization of Pharmacologic, Nonpharmacologic and Self-Healing Therapies: A Pilot Study

Purpose: Both pharmacologic and non-drug therapies are essential components of a multimodal analgesic treatment strategy and best practice dictates that pain treatments need to be tailored to individual patients. Although the use of nonpharmacological therapies for pain management are supported by treatment guidelines, they are often underutilized for perceived lack of knowledge, efficacy, or access. We sought to gain insights from practicing clinicians regarding perceived analgesic effectiveness and understand their utilization patterns of select pharmacologic, complementary and self-healing analgesic therapies.

Methods: A survey was sent to pain clinicians across various geographies in the US and results stratified by title (attending, resident, etc), specialty (anesthesia, PM&R, etc) and years of experience. Respondents were queried on their perceptions about how effective individual modalities were for chronic pain using a numeric scale; we also queried frequency of use out of 100 most recently treated patients at their practice. Modalities included pharmacologic (NSAIDS, opioids, etc), nonpharmacologic (yoga, pain psychology, etc), and interventional (nerve blocks, stimulators). Clinicians were asked to rate agreement with singular statements including benefit of sleep on pain, use of nonpharmacologic devices, and validity of cognitive behavioral and self-healing strategies to reduce pain.

Results: A variety of clinicians responded, including Pain Management, Anesthesiology, Primary Care, Physical Medicine and Rehabilitation, and Orthopedic Surgery, although 90% of respondents were anesthesia or PM&R trained. Responses in general favored NSAIDS and acetaminophen, as well as joint and spine injection procedures. Respondents were divided for topical analgesics and the use of devices to modulate pain (through electricity, magnetism, direct contact, or similar mechanisms). They were generally not supportive of acupuncture, yoga, benzodiazepines and opioids, although only 10% of respondents did not prescribe opioids within their last 100 treated patients. Spinal and joint injections had the highest perceived efficacy for pain (8/10) while benzodiazepines had the lowest (3/10). Most agreed that sleep quality and quantity are directly related to pain, that use of mind:body medicine techniques significantly lowers patient perception of pain, and that patients have an innate ability to promote “self-healing” through diet, exercise and cognitive behavioral strategies to reduce perception of pain. On a 0-10 scale, 70% of clinicians responded ≥8/10 that humans have an innate ability to promote self-healing through diet, exercise and cognitive behavioral strategies.

Conclusion: In our sample of clinicians who treat patients with pain, it appears that pharmacologic therapies like acetaminophen and NSAIDs, as well as interventional therapies such as joint and spine injection remain first-line preferred treatment options; respondents find only moderate utility for topical and nonpharmacologic therapies. Although clinicians agree with the concepts of improved sleep, mind:body medicine and innate self-healing abilities, traditional pharmacological and interventional approaches still prevail. Our data suggests an unmet need for further exploration of self-healing and nonpharmacological therapies to augment our innate biology and promote analgesia. If effective, provider and payer education will likely be required to include these modalities as part of a comprehensive pain treatment plan.

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