Telehealth and Pain Management: What You Need to Know



When you’re feeling debilitating pain, the last thing you want to do is hop on public transport or get in a car (perhaps with kids) and see your doctor. Instead, you can log into a telehealth appointment with your healthcare professional (HCP) today for evaluation, pain medication prescriptions, and follow-up care from the comfort of your home. But telehealth for pain management has its pros and cons and is still evolving.

HealthyWomen WomenTalk section brought together experts to discuss the future of telehealth and pain management. Senior scientific advisor to healthy women Monica Mallampalli, Ph.D.joined Dr. Anita GuptaD., assistant professor of anesthesiology, intensive care medicine, and pain medicine at the Johns Hopkins University School of Medicine. Kate NicholsonManaging director of the National Pain Advocacy Center.

“Telehealth really, really kicked in for people,” Nicholson said in the webinar. “It has proven beneficial not only for immediate access, but for people with chronic pain as well… going to an appointment actually increases their pain, even if they go for treatment and pain relief.”

According to a McKinsey and Company report, Telehealth usage has increased 38 times between pre-pandemic start and 2021. Nicholson explained that telehealth beneficiaries include women with childcare responsibilities, people facing transportation barriers, and people living in rural areas who would otherwise have to travel long distances to get health care. phone interview.

“Telehealth has literally been a lifeline for many, especially those in pain,” Malampalli said in the webinar. Said. “Telehealth has become an important way for clinicians to use telehealth visits to carefully discuss treatment options with their patients, particularly female patients.”

At the height of the pandemic, Gupta, along with a team of Princeton University students and researchers, conducted a pilot study to understand the effectiveness of telehealth and analyzed HCPs’ comfort levels with telehealth with patients – particularly opioid education – and their overall understanding of treating patients. abilities.

“What we uncovered is, [the experience] “It’s very similar, if not potentially better, than traditional ways of caring for patients,” Gupta explained in the webinar. The study was small, but Gupta added, “What this shows is that telehealth and other innovations in this field are the ones that desperately need care for … the pain.” It shows that there is a possibility to help these patients who are attracting, needing medication guidance. , especially regarding opioid therapy.”

One of the biggest game changers for pain sufferers is that Covid-19 has paved the way for providers to prescribe pain medication without the need to see their patients in person. Ryan Haight’s LawEnacted in 2008, it requires Health Care Professionals to perform at least one face-to-face examination before issuing a prescription for a controlled substance, including opioids.

In March 2020, as Covid-19 spread rapidly, the Drug Enforcement Agency temporarily suspended requirement in person as a result of a federal public health emergency notification. This suspension is what gives HCPs the flexibility to prescribe opioids and other controlled substances for pain management through telehealth appointments. The public health statement has been extended multiple times – currently until July 15, 2022 – and is expected to be renewed until October 2022. However, when they expire, the face-to-face review requirement for these prescriptions will continue unless approved by Congress or the Department of Health. and Human Services intervene.

“[Telehealth] “He’s provided a really important bridge, and it’s a bridge we need to continue because it provides a level of access to care that we don’t necessarily see across the healthcare system,” said Nicholson. But he added that there is still a lot of work to be done to iterate on what worked and fix what didn’t.

Any innovation has disadvantages. While telehealth provides access for many people, inequalities still exist. People who do not have adequate internet access or do not have the knowledge to participate in a video call may be left behind. a study It found that young adults aged 18-24 (72.5%), those earning at least $100,000 (68.8%), those with private insurance (65.9%), and whites (61.9%) used video telehealth the most.

“We have to be mindful of the digital divide and the fact that broadband services are not widely available to everyone; Not everyone has a computer,” Nicholson said. “So it’s important that audio-only telehealth or virtual care is available to people as well.”

Privacy is also a concern for women who have a house full of family or roommates who may be overheard on dates or, worse, victims of domestic violence who want to keep their privacy from their partner. In addition to restrictions to curb opioid abuse, there are confusing insurance reimbursement rules at the state and federal level that are not clear.

These may be some of the reasons why the Centers for Disease Control released the updated draft report. Clinical Practice Guidelines for Prescribing Opioids earlier this year, there were no prescriptions via telehealth.

“We have moved very quickly during the pandemic and are moving forward, but innovation has its challenges. There [is] “When we talk about guidelines and best practices for a complex crisis, we’re not there yet.”

The future of telehealth pain management is uncertain, particularly in terms of opioid prescription. A bipartisan group in Congress, TREATMENTS Act permanently expand some of the flexibility given to providers during the pandemic, and More than 70 medical organizations They asked the DEA to permanently waive its telehealth prescribing restrictions. Nicholson recommended that people who want to continue this access via telehealth should talk.

“It really helps to talk to your elected representatives, because that’s what needs to be done,” he said. “I would call their staff and say, ‘Listen, telehealth is very important to me.’… I have a great faith in people advocating directly with policymakers.”

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