Disease Management Update
Volume V, No. 4
May 22, 2008

Dear Healthcare Intelligence Network Client,

According to the American Academy of Pain Management, about 50 million Americans are living with chronic pain, whether due to a disease, a disorder or an accident. On top of that statistic, another 25 million people suffer acute pain brought on by surgery or accident. And more than 60 percent of chronic pain patients have been living with their pain for more than five years.

This week's Disease Management Update looks at therapies used to treat pain as well as the social and legal barriers preventing many healthcare professionals from adequately managing their patients' pain issues.

We recently conducted an e-survey on pain management programs and received more than 200 responses. The e-summary will be available soon. If you'd like a copy, please send an email to editor@hin.com.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at: http://www.hin.com/dmdesktop/diseasemanagement.html

Table of Contents

  1. Acupuncture and Myofascial Trigger Therapy Treat Same Pain Areas
  2. Disease Management Q&A: Reducing Chronic Pain
  3. HealthSounds Podcast: Managing the Chronic Pain Patient
  4. Physicians Try to Break the Stigma of Pain Management Therapies
  5. Survey of the Month: Patient Registries
  6. Condition-specific Pain Management: Managing a Major Source of Lost Productivity

1. Acupuncture and Myofascial Trigger Therapy Treat Same Pain Areas

Although acupuncture and myofascial trigger therapy each have a different focus on treating pain, the two techniques treat the same pain areas. Results of a Mayo Clinic study suggest that people who want relief from chronic musculoskeletal pain may benefit from either ancient acupuncture or modern myofascial pain therapy, says Dr. Peter Dorsher, chronic pain specialist for the Department of Physical Medicine and Rehabilitation at Mayo Clinic. The study found that at least 92 percent of common trigger points anatomically corresponded with acupoints, and that their clinical correspondence in treating pain was more than 95 percent.

Classic Chinese acupuncture treats pain and a variety of health disorders using fine needles to "reset" nerve transmission, Dorsher says. Needles are inserted in one or several of 361 classical acupoints to target specific organs or pain problems. Myofascial trigger-point therapy, which has evolved since the mid-1800s, focuses on tender muscle or "trigger point" regions. There are about 255 such regions described by the Trigger Point Manual, the seminal textbook on myofascial pain. These are believed to be sensitive and painful areas of muscle and fascia, the web of soft tissue that surrounds muscle, bones, organs and other body structures. To relieve pain at these trigger points, practitioners use injections, deep pressure, massage, mechanical vibration, electrical stimulation and stretching, among other techniques.

To learn more about this study, please visit:

2. Disease Management Q&A: Reducing Chronic Pain

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Danielle Butin, formerdirector of Northeast Health Services, Secure Horizons, a division of UnitedHealthcare.

Question: What are some guidelines for reducing chronic pain patients?

Response: (Danielle Butin) Educate members on alternative techniques for reducing chronic pain. We’ve contracted with Dr. Ingrid Bacci, an alternative medicine provider. She teaches countless strategies for pain management, including self-talk, cognitive behavioral strategies, imagery, posture and bed mobility. She’s a fantastic practitioner, and we’ve had over 300 members enrolled. We don’t have any other interdisciplinary health professionals. Within six months of attending this program, there are $142 in PMPM savings. Most notably, within six months of attending the program, there’s a 64 percent reduction in narcotic use by those taking intensive narcotics to treat their condition. Coaching is also effective and should be made available from a variety of disciplines for the Medicare population. Do not make the assumption that one discipline will be effective for everyone. When older adults are exposed to a wide variety of expertise, we see results.

For more details on coordinating care, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Managing the Chronic Pain Patient

According to Marilee Donovan, a big part of pain management is self-management. In this podcast, Donovan, regional pain management coordinator with Kaiser Permanente, discusses Kaiser Permanente's multi-disciplinary chronic pain management program, as well as the measures she relies on to assess pain in and improve the quality of life for her patients.

To listen to this complimentary HIN podcast, please visit:

4. Physicians Try to Break the Stigma of Pain Management Therapies

A report released by the American Pain Foundation (APF) outlines critical barriers to appropriate opioid prescribing for pain management and calls for a more balanced perspective of the risks and benefits of these medications in practice and policy. Roundtable participants agree that a shift towards a more balanced view of opioid therapy is essential.

“Alleviating pain has always been a basic tenet of medicine. Still, pain remains woefully undertreated due, in part, to the misconceptions, fears and stigma surrounding pain management, especially the use of strong pain medications,” says Will Rowe, CEO of the APF and co-moderator of the meeting. “We convened this roundtable of esteemed leaders in the pain field as a critical first step to elevate the national dialogue about opioid therapy and identify ways to start building consensus for what has, at times, been a very divisive issue.”

An online survey of nearly 240 PCPs, pain specialists, nurse practitioners and physician assistants cited fears of legal issues and addiction as top challenges to prescribing opioids as part of a pain management plan. In addition, 45 percent believe most physicians base their decision to prescribe opioids on non-clinical considerations like societal and legal issues.

“We need to reduce the stigma around these medications and ensure that patients with a legitimate medical need have access to opioid therapy as indicated by their health care provider,” says APF Director of Advocacy Micke Brown, R.N., BSN.

To view more of this study's findings, please visit:

5. Survey of the Month: Patient Registries

Many healthcare organizations use patient registries to create a realistic view of clinical practice, patient outcomes, safety and comparative effectiveness and to support evidence development and decision-making. Complete our online survey on patient registries by May 31, and you'll receive a free summary of the results.

To participate in this survey and receive its results, please visit: http://www.surveymonkey.com/s.aspx?sm=5OTbdp3eEaksGtQNlOyqyA_3d_3d

6. Condition-specific Pain Management: Managing a Major Source of Lost Productivity

Disease management providers expanded their program offerings to encompass entire disease populations and addressed diseases such as diabetes and asthma that have higher prevalence rates. While these diseases have lower inpatient costs than heart failure or COPD, their higher prevalence rate results in a larger number of outpatient visits, each of which is usually associated with a lost day of productivity. Disease management programs that provide the greatest assistance in maintaining a healthy productive workforce are ones that address a large number of preventable utilization events, lower unnecessary absences from work and keep the employee healthier and better able to concentrate on his or her job.

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