Opioids are one of a number of options in the MHS pain management toolbox (Photo by: Medline, National Institutes of Health).

"Our numbers are looking better, but the pain program is so much more than just getting the numbers down. We need to provide pain care in locations where it is needed so opioids become one of a number of options in our toolbox," said Army Lt. Col. Lori Whitney, director of the Army Comprehensive Pain Management Program.

Why the Declines?

The lower number of prescriptions is attributed in part to the recent emphasis of non-pharmacological approaches to pain management. At the same time, new education programs for health providers and patients have increased awareness of both the risks of opioids and the complementary forms of pain management therapy.

Provider training includes:

• Emphasis on avoiding routine prescription of opioids as a first-line therapy for minor pain conditions
• Developing pain management plans that ensure patients are taking the lowest effective dose of opioids for the shortest time
• Monitoring patients' conditions closely with the aim of risk mitigation

"The training provides a whole array of data and data tools that allow the prescriber to compare their prescribing practices to their peers at the level of the MTF [medical treatment facility], region, and market," Whitney said. These tools can also be used by leadership.

Patient and provider education follows the Step Care Model of pain management that was developed by the Department of Veterans Affairs, where the goals and emphasis is on the "return to function and restoration of health."

Other interventions focus on:

• Non-opioid pain management treatments such as nonsteroidal anti-inflammatories
• Complimentary pain management techniques like chiropractic manipulation, acupuncture, and massage therapy
• Behavioral interventions such as cognitive behavioral therapy and mindfulness meditation
• Patient lifestyle components like sleep and diet

Improving the quality of pain management in the MHS has been a key priority for the Defense Health Agency in recent years. The objectives of the DHA's pain strategy are designed to:

• Educate patients in effective self-management of pain and injury rehabilitation
• Educate clinicians regarding effective pain management and opioid safety
• Provide tools, including those through the MHS GENESIS, Carepoint, and legacy electronic health records systems to assist clinicians in evidence-based and patient-centered pain management
• Conduct pain research to continuously improve the approach to pain management

Additionally, the MHS Prescription Drug Monitoring Programs electronic database collects prescription data on controlled medications dispensed to TRICARE beneficiaries within the MHS. MHS then shares prescription drug monitoring information from military hospitals, clinics, and pharmacies with civilian health care providers and pharmacies.

"It's important that the MHS is leading this effort in that both federal partners, such as the VA, and civilian health care teams are looking to replicate our successes," said Dr. Christopher Spevak, an anesthesiologist and pain physician at Walter Reed National Military Medical Center in Bethesda, Maryland. Spevak leads the National Capital Region Pain Initiative and Tele-Pain Program.