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Massachusetts is on the frontline of a national health crisis. In 2016, opioids killed or were suspected of killing five times as many people as car accidents. Last year, opioid-related deaths in our state surpassed the national average.
Government officials on the local, state, and federal level are joining forces to address the opioid epidemic. Approaches range from “abuse-deterrent formulations” (drugs that can’t be crushed) to making NARCAN available to the public. They’ve also targeted health care providers, holding them accountable for overprescribing these powerful painkillers.
Prescription for disaster
In the 1960s, heroin users were usually young men from low-income neighborhoods, who started using around the age of 16. When they turned to opiates, heroin was their first choice. Today, the average heroin addict starts using at age 23, lives in an affluent suburb, and gets their first opiates via a doctor’s prescription.
The link between prescribed opiates and heroin is glaringly obvious. If you’re hooked on OxyContin or Vicodin and your provider cuts you off, what do you do? On the street, one 80 mg OxyContin pill can set you back $80. Heroin, on the other hand, might cost only $45 for a multi-dose supply.
While it’s easy to blame health care providers for over-prescribing opiates, one must acknowledge the perfect storm of factors that led them to do so, including the system the health care uses to assess pain.
The problem with the pain scale
The misuse of opioids escalated in the mid-1990s with the introduction and marketing of new opioid drugs, and the simultaneous introduction of a new emphasis on measuring pain as “a fifth vital sign.”
Providers adopted a ten-point pain scale to assess and record patients’ pain levels. Like many healthcare initiatives, health care professionals designed the pain scale for patients, not with them.
By asking all patients to use the same, decontextualized number line to assess how much they hurt, this pain scale ignores the fact that pain is a deeply subjective phenomenon, influenced by isolation, fear, anxiety and uncertainty. It reduces everything a patient feels into a single numeric score. It’s not administered or explained with any consistency, leading to lack of reliability across patients and between patients and providers.
In 2011, the Institute of Medicine’s report on Relieving Pain in America noted that “significant improvements are needed to ensure that pain assessment techniques and practices are high-quality and comprehensive.” The current ubiquitous use of the ten-point scale is particularly problematic because pain assessment plays a pivotal role in pain treatment.
Wanted: a human-centered solution
We have a significant opportunity to better calibrate the prescribing of opioids to actual needs of patients through the co-designing of solutions with patients, by:
- Establishing a common language for patients and providers to use when they talk about pain
- Incorporating the needs and values of all key stakeholders
- Developing new options for assessing pain based on best practices and current models (e.g. the American Chronic Pain Association Quality of Life Scale and the Geisinger pain scale)
- Promoting an expanded understanding of the range of pain treatments available to patients
Collaboration is the new innovation!
Human-centered design is a promising model for innovation that can get us from where we are to where we want to be. This methodology allows the people who will be affected by the solutions we create to participate in the creation process. The result: solutions that truly serve them.
Early experiments have shown that improving pain assessment tools can reduce the prescribing and use of opioids. Mad*Pow’s Center for Health Experience Design (CHXD), Massachusetts Health Quality Partners (MHQP), and Cigna are all working together with patients and clinicians to envision a new tool that improves the conversations they have around pain. Future CHXD plans for this project include validating this tool with clinical partners and developing an evidence-based rationale for its usage. And, then, we’ll share our results with the industry such that the new method can be adopted. Ultimately, our goal is to give providers and patients a way to deal with pain wisely, compassionately, and carefully.
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