P&T Digest: Pain Management

Randall P. Brewer, MD, Chief Medical Editor

Chronic pain is a significant public health issue in the United States and an important concern for MCOs. Untreated or undertreated pain can evolve from a symptom to a chronic condition in its own right, one that has serious comorbid, economic, and quality-of-life consequences. As scientific understanding of the mechanisms involved in chronic pain increases, so too does the opportunity to manage affected patients in a cost-effective manner.

This peer-reviewed digest discusses the clinical and economic implications of chronic and acute pain, current guidelines for treatment, therapeutic approaches to care, and patient-management strategies. It also discusses legal and clinical considerations of opioid and nonopioid therapies for adult and geriatric populations. In consolidating the state of the art about this increasingly important subspecialty of medical care, this is a valuable tool for physicians and other clinicians, managed care clinical executives, and P&T committee members.


  • Addressing Pain Management Challenges in Managed Care
  • Conceptualizing Pain and Improving Pain Diagnosis and Assessment
  • Prevalence and Economic Implications of Chronic Pain the United States
  • Guidelines for Pain Management
  • Balancing Patient Needs and Provider Responsibilities in the Use of Opioids
  • Delivery Systems: Advantages and Disadvantages
  • Benefits of Pain Management in the Elderly
  • The Value of Multidisciplinary Care

Managed Care’s Top Ten Articles of 2016

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Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
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Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.