The Next Era of Pain Management: The Convergence of Scientific Innovation and Public Policy Incentivization

Pain management has come a long way in the last 20 years. Some in the industry, myself included, are cautiously optimistic that we’ve stepped into a new era. The old model — “an opioid for almost every kind of pain” — is increasingly recognized as an outdated and risk-laden approach. As such, we’re seeing yesterday’s standard of care being replaced by a more nuanced and patient-centric approach, which includes novel non-opioid therapies that provide highly effective pain control without the side effect burden, nor the risk for severe downstream consequences such as addiction or dependence, associated with opioid-based prescribing. 

But we need to press on: While the latest numbers suggest some progress against the opioid epidemic, it’s still a national crisis. In 2023 alone, 107,543 Americans died from opioid dependence. 

The “gateway” to opioid misuse is too often prescriptions after surgery. Research tells us that nearly 9% of surgical patients may become persistent opioid users following surgery, with the number climbing as high as 17% for certain surgery types. Staggeringly, women are 40% more likely than men to be affected. And not only are people at risk after their own surgeries, but so are family and community members. Unused prescriptions can make their way to others, in a phenomenon known as “diversion.” 

Fortunately, the last 15 years have brought wide recognition that as a healthcare system, we need to change the status quo. The development of opioid-sparing strategies is one piece of the equation — policy to support their uptake is the other. 

And both are taking shape. 

On the scientific front, FDA-approved non-opioid options have been on the market for more than a decade, with more on the horizon. Medicines and devices that spare people from opioids have numerous benefits, not the least of which is that they reduce the rise of opioid use disorder (OUD). Importantly for patients, their availability can remove the fear that may keep people from seeking necessary or life-changing care, including those in recovery from substance use disorders who may resist treatment for fear of relapse. And although concerns have been raised about their cost relative to generally inexpensive opioids, non-opioids can actually reduce long-term societal healthcare costs because they eliminate the downstream costs of OUD. Treatment for OUD, medical expenses, and lost work can cost in the ballpark of $1.5 trillion per year. 

Along with scientific advances, policies to support access to these therapies are also gaining traction. The Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act is a critical piece of legislation, passed by Congress in 2022, which will improve access to non-opioid options for millions of patients beginning January 1, 2025. Its passage was the culmination of years of work and coalition building across 125 stakeholder organizations spanning medical societies, advocacy groups, and healthcare systems, and captured bipartisan support from both the House and Senate. The legislation mandates that Medicare provide separate reimbursement for qualifying non-opioid options used in all outpatient surgical settings.  

Given that overdose deaths among seniors have climbed precipitously in the last decade, and because this population is particularly vulnerable to opioid-related side effects that can delay surgical recovery, Medicare is an important entry point for the implementation of revised reimbursement policy to increase patient and provider access to non-opioid pain management options. 

But there’s much more work to be done. 

The scientific community must continue cross-industry collaboration to develop even more innovative approaches to treating various types of pain — from acute to chronic, from musculoskeletal to migraine, and beyond. This will require continued investment in the foundational science to elucidate remaining unknowns regarding how pain works in the body and brain. Which in turn can direct us to even more targeted strategies to address the physiology behind specific pain types. 

And we must continue to work together on the policy front, to provide greater access to non-opioid therapies. NOPAIN’s reimbursement can only have the intended impact if health systems choose to implement it. Beyond Medicare reimbursement, NOPAIN must be adopted by other payors, particularly commercial and private medical and dental insurers. 

Finally, no shift in practice is possible without education. Most people are hyper aware of the opioid epidemic but may be less aware of the entry points — like prescription opioids — and how to navigate around them. It’s critical for patients and providers to discuss options, and for patients to be encouraged to ask questions. This is especially true for groups historically under-treated for pain, as well as those at greatest risk of OUD, for whom newer pain care options are even more crucial. 

The new era of pain care is here — but it will take all of us: industry leaders, scientific expertise, and continued policy pressure to ensure that all patients have access to appropriate non-opioid interventions to allow them to reimagine life beyond pain.

Photo: sorbetto, Getty Images

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