The Power of Al­ter­na­tives

Get Bet­ter Pain Care in Your Hospi­tal or Med­i­cal Fa­cil­ity

Alternative Medicine - - The Big Picture - BY JOHN WEEKS

You have a new and pow­er­ful ally to get your pri­mary care provider, hospi­tal, or med­i­cal fa­cil­ity to of­fer more than drugs and surgery when it comes to pain treat­ment. A po­lice force called The Joint Com­mis­sion has jumped in with both feet on the side of new op­tions.

The Joint Com­mis­sion—for­merly the Joint Com­mis­sion on Ac­cred­i­ta­tion of Health­care Or­ga­ni­za­tions—is the ac­cred­it­ing agency for most of the na­tion’s hos­pi­tals and for a grow­ing num­ber of pri­mary care clin­ics, se­nior homes, and other health­care de­liv­ery units.

On Novem­ber 12, 2014, this quasi-gov­ern­men­tal agency took two im­por­tant steps. First, it el­e­vated “non­phar­ma­co­logic” meth­ods from last re­sort to early con­sid­er­a­tion and use. The agency specif­i­cally gave a shout out to the ev­i­dence for acupunc­ture, mas­sage, chi­ro­prac­tic, re­lax­ation ther­apy, and be­hav­ioral ther­apy.

The Joint Com­mis­sion then took a swipe at any fa­cil­ity or prac­ti­tioner of­fer­ing a one-sided, rosy pre­sen­ta­tion of the value of opi­oids and other painkillers. Pa­tients are to be told about known risks. For in­stance, the very use of opi­oids has been found to be a cause of chronic pain.

This is big news. If you or a loved one are seek­ing in­te­gra­tive treat­ment, you are no longer an iso­lated in­di­vid­ual de­mand­ing op­tions. The med­i­cal in­dus­try’s po­lice power is at your side. Here’s how this can work.

First, some back­ground on ac­cred­i­ta­tion. Think of a school or hospi­tal that ad­ver­tises that it meets or ex­ceeds the high­est stan­dards. How can one know if the claims are not merely hot air?

In the United States, we evolved “third par­ties”—nei­ther you nor the hospi­tal, in this case—called ac­cred­it­ing agen­cies to en­sure that such mar­ket­ing isn’t a pack of lies. The mo­tive is pub­lic pro­tec­tion. Th­ese agen­cies are not for­mally gov­ern­men­tal but have tremen­dous quasi-gov­ern­men­tal power. If a school loses ac­cred­i­ta­tion, for in­stance, stu­dents lose ac­cess to guar­an­teed stu­dent loans, fac­ulty, and grants. Loss of such rev­enues can be life or death.

For hos­pi­tals, an elab­o­rate ma­trix of re­la­tion­ships with aca­demic part­ners, cor­po­rate pur­chasers, govern­ment agen­cies, grant fund­ing, and pa­tient re­spect rest on an ac­cred­i­tor’s thumbs up. It pays to stay on the good side of the law.

There’s a new sher­iff in town—ef­fec­tive Jan­uary 1, 2015—in the wild west of opi­oid pre­scrib­ing: The Joint Com­mis­sion’s “Clar­i­fi­ca­tion to Stan­dard PC.01.02.07.” The doc­u­ment starts by say­ing that what fol­lows ap­plies to The Joint Com­mis­sion’s en­tire uni­verse of ac­cred­ited en­ti­ties: “Am­bu­la­tory Care, Crit­i­cal Ac­cess Hospi­tal, Home Care, Hospi­tal, Nurs­ing Care Cen­ters, and Of­fice-Based Surgery Prac­tice Pro­grams.”

The Joint Com­mis­sion re­it­er­ates that the fa­cil­ity must part­ner with pa­tients. Then both non-phar­ma­co­logic and phar­ma­co­logic ap­proaches are in­tro­duced as “hav­ing a role in the man­age­ment of pain.” Listed first are the nu­mer­ous non-phar­ma­co­logic, in­te­gra­tive op­tions. Only then are the op­tions that presently dom­i­nate treat­ment of pain listed: “phar­ma­co­logic strate­gies: nono­pi­oid, opi­oid, and ad­ju­vant anal­gesics.”

Even as the value of the for­mer are el­e­vated by ev­i­dence-based medicine’s re­quire­ment that this step was taken “fol­low­ing ex­ten­sive lit­er­a­ture re­view,” the lat­ter takes a hit based on the same ev­i­den­tiary process. Prac­ti­tion­ers are to as­sess “the risks and ben­e­fits as­so­ci­ated with the strate­gies, in­clud­ing po­ten­tial risk of de­pen­dency, ad­dic­tion, and abuse.”

While one can imag­ine ad­dic­tion to mas­sage, chi­ro­prac­tic, or acupunc­ture,

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