William "Smitty" Pignatelli: An integrated solution to pain management and the opioid crisis

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LENOX — Most of you who know me already know that I'm an avid supporter of integrated pain management methods. I'll be the first one to tell you that I've personally benefited from receiving integrated treatment right in Southern Berkshire County. About four years ago, I felt a pain that can most generally be described as "tennis elbow." I went to my primary care physician, tried everything I could think of, and even paid out of pocket to see a nerve specialist who still couldn't fix my problems. I could barely shake someone's hand without pain shooting up my arm. "Don't shake so many hands," I was told, and that's when I decided to try acupuncture. I had one session every week for four weeks straight and my pain disappeared.

NON-INVASIVE

That was over four years ago at this point and the pain in my elbow has never been back. All this was accomplished without surgeries or prescriptions, but rather through a completely non-invasive and non-addictive treatment. I improved without having to take a single pill.

I learned that acupuncture, and various alternative modalities, when integrated, are proven to create a smoother path to rehabilitation after a surgery, injury, past addiction, or other cause of chronic pain. Since then it's been obvious to me that no one, no matter where they're from or who they are, should have to choose from a narrow scope of pain management options, most of which run the risk of long-term addiction.

On Oct. 29, the treatment I received four years ago led me to the selectmen's meeting room at Lenox Town Hall where I hosted an information session connecting representatives from the health care industry in the Berkshires with officials from the Massachusetts Division of Insurance (DOI) Health Care Access Bureau. After several sessions of filing bills that would provide coverage for integrated pain management therapies, most specifically acupuncture, language I filed requiring insurance carriers to offer a "broad spectrum of alternative pain management coverage, including but not limited to non-pharmaceutical options," was included in the omnibus opioid prevention bill that was signed by Governor Baker this August. The law names DOI as the agency charged with creating the guidelines insurance carriers will now have to follow to provide integrated pain management coverage.

Representatives from Berkshire Health Systems, the Brien Center, Volunteers in Medicine, local area acupuncturists, pain physicians from Berkshire Medical Center and spokesmen from the Acupuncturists Society of Massachusetts met with DOI to highlight the need for stronger integrated pain management coverage in Massachusetts, and the hurdles that patients and providers both face in trying to access and provide these services. We had a healthy discussion on our overall need to curb the epidemic from the front end by reducing the number of opioids prescribed for pain relief, and the unfortunate fact that professionals in the Berkshires can't see a great number of patients here due to the inability to afford treatment.

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The Division of Insurance made it clear that they would have to work within the existing insurance structure in Massachusetts that requires a pathology and diagnoses-centered model to allow services to be contracted and covered at pre-established rates. They also brought up the challenge they face of balancing deductibles and monthly premiums and finding a way to integrate these new services through brand new guidelines, the first guidelines that the DOI has ever been charged with creating.

The facts remain, however, that we know integrated therapies work thanks to proven studies and effective treatments, and we know that carriers have methods of providing coverage for them now. Hillcrest Cancer Center, Berkshire Health Systems, Dana-Farber Cancer Institute, Boston Children's Hospital and Bay State Hospital in Springfield have all reported success in using acupuncture for both pain management and nausea in cancer patients. Heavy insurance industry hitters such as Harvard Pilgrim and Blue Cross Blue Shield also cover acupuncture services through several existing plans. Everyone who qualifies for medical coverage through the Department of Veterans Affairs automatically qualifies for 100-percent covered acupuncture treatments through the Veterans Choice Program, and at one point the New England School of Acupuncture even received a federal grant from the Department of Defense to continue acupuncture treatments due to their success in treating veterans exhibiting PTSD.

Monday's session in Lenox allowed local specialists to respond to the DOI with detailed results they've personally seen after using a holistic approach to their patients' pain. They walked the DOI through the steps of receiving integrated treatment - both what should happen and what actually does - from the initial primary physician referral to the creation of a management plan, and they reminded the DOI of the need to provide our residents with options other than opioids. I believe one of the most important takeaways came from the Brien Center, when they said the new guidelines should at bare minimum include services for substance use treatment and detox as well as chronic pain diagnoses. I agree that it's important to take responsibility for our prescribing practices up to this point and make sure those who can benefit from integrated therapies as part of their detox and recovery are able to do so to the fullest extent.

CREATING GUIDELINES

I trust the DOI will agree that the information session in Lenox went well and offered them important insight into both the Berkshires and the world of integrated pain management. I hope the other three sessions they have scheduled across the state will help build on our conversations and create solid guidelines for regulated insurance carriers to follow. An essential point that came up most in the meeting, however, was the fact that this is only "Step One" in a long and lengthy process. Once we get into the arena of integrated pain management coverage in Massachusetts, we as a state and the Legislature back in Boston will start receiving more input from providers, patients and insurance carriers. It was on us to crack open this door for constituents suffering from pain and substance use to afford access to integrated services. Doing so also makes it possible for us to get more information to continue perfecting coverage for integrated pain management and for our health care system as a whole.

Again, the new law does not currently specify acupuncture or any other particular form of pain management, but rather a "broad spectrum" of therapies that can include yoga, massage, diet, nutrition and mindfulness, just to name a few others. It's easy to forget, unless you're in the circumstance yourself, that pain and addiction have a very negative effect on a person's social and psychological well-being. I'm grateful to everyone who participated that Monday morning to help us find a way to make it easier for folks in these circumstances to recover and move on to lead productive, fulfilling lives. I understand our Lenox meeting was part of the very beginning, but I'm happy to be taking a step in the right direction and I look forward providing my full support to integrated pain management coverage at every step of the way. William "Smitty" Pignatelli is the state representative for 4th Berkshire.


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