The Power of Alternatives
Get Better Pain Care in Your Hospital or Medical Facility
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,