New Ways to Treat Pain Meet Insurer Resistance

New Ways to Treat Pain Meet Resistance – The New York Times

In recent months, federal agencies and state health officials have urged doctors to first treat pain without using opioids, and some have announced plans to restrict how many pain pills a doctor can prescribe.

But getting the millions of people with chronic pain to turn to alternative treatments is a daunting task, one that must overcome inconsistent insurance coverage as well as some resistance from patients and their doctors, who know the ease and effectiveness of pain medications.  

Alternative treatments for pain may include chiropractic and osteopathic manipulation, meditation, massage, yoga, acupuncture and cognitive behavioral therapy, which helps people cope with pain by changing how they think about it.

Insurance plans may not cover all of these treatments, which vary widely in cost, or impose strict limits on them. Comprehensive programs such as the one Mr. Scott attended are expensive, charging $20,000 or more.

Many state Medicaid programs for the poor, while eager to reduce opioid use among their members, have only begun to grapple with whether to cover nondrug treatments for pain, or how extensively to do it.

These people seriously believe they can take away pain medication and then require patients to fend for themselves when they already live in poverty.

This is cruel, plain and simple.

One exception is physical therapy, which Medicaid is required to cover for members who gained coverage under the Affordable Care Act. But the generosity of the benefit varies by state.

Mr. Salo added that such benefits were often the first to be eliminated when program budgets are cut because the treatments are considered optional.

Evidence about the effectiveness of the treatments varies widely, adding another layer of complication. The proof is limited for acupuncture, for example, but better for cognitive behavioral therapy.

Until this latest “crisis”, most doctors looked down on and denigrated the very treatments they are now recommending and sending us to.

They claimed there was no evidence for their effectiveness, and mostly, this is still true. Still, only patients themselves can determine if a treatment is successful for them.

Statistics are useless for individual treatment. It is utterly irrelevant that a medication works for 99% of patients if it does not work for you personally.

Medical treatment requires professional judgment, not merely the application of statistical results. (Yet this is exactly what is being proposed by many healthcare experts as the dream of the future by getting rid of those pesky doctors spending so much time with patients and trying so many different modalities.)

Still, some insurers will not pay for such multifaceted treatment, questioning both their effectiveness and value.

So, the government wants us to stop taking opioids and use alternative treatments, but those that would have to pay refuse to do so, and patients are left abandoned to their pain.

This is a sickness plaguing our society: everybody wants better things and no one wants to pay for them, so citizens are left abandoned without anything.

In addition, patients often resist nondrug treatments. Taking a pill is simply faster and easier than regularly leaving work for physical therapy.

They state this as though it were a choice, assuming everyone is allowed to take regular leaves from their work. So many Americans are barely able to hold on to jobs where even a single absence can result in being fired.

These people making rules for us are completely out of touch with what life is like for the average person.

In the 1990s, insurers often supported programs like the one in Jacksonville. But they soon fell out of favor because the programs varied in quality and there was little data to show their long-term value.

This is still true. The treatments have not changed, only their approval by mainstream medicine has.

In addition, opioids appeared to provide a quicker and cheaper solution.

“Insurers started saying, ‘What the heck, why are we throwing money at a problem?’” said Dr. Deitz, the consultant.

In a statement, Florida Blue said that while it covered some of the alternative techniques like physical therapy used in Dr. Wittmer’s program, it considered other approaches experimental and unproved.  

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