June 21, 2021
National Center for Health Research’s Comments on Agency for Healthcare Research and Quality’s Draft Report on Integrated Pain Management Programs
We are writing to express our views on the Agency for Healthcare Research and Quality’s (AHRQ) draft report on integrated pain management programs.
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
While we agree with the stated objective of a report evaluating the effectiveness and harms of pain management programs in the Medicare population, this report has several serious limitations.
A major concern is the age of the patients in the trials. The mean age of patients across trials on comprehensive pain management was 45 years old. Only 4 trials cited in the report studied patients with a mean age over 60 years old, and there is no mention of subgroup analyses for any patients over 65 for any studies reviewed. Although a small proportion of Medicare beneficiaries are younger than 65, those younger beneficiaries either have also qualified for Social Security disability for at least 2 years or have been diagnosed with end-stage renal disease. Therefore, the patients studied are not representative of Medicare beneficiaries, and it would be inappropriate to extrapolate the findings to the Medicare population.
Another major shortcoming is that, as stated in the review, patients in most trials on pain management had moderate chronic pain from musculoskeletal pain and fibromyalgia. This is a limited scope and not representative of the broad range of chronic pain experienced by those in the Medicare population.
For these reasons, the research reviewed in this report fails to adequately discuss the effectiveness of integrated and comprehensive pain management programs for the Medicare population. The admitted caveat that the “findings are potentially applicable to the Medicare population” [emphasis ours] is not adequate to convey these shortcomings. The report needs to be revised to more clearly indicate these shortcomings and, if possible, determine if subgroup analyses are possible to better determine whether any of the studies have implications for Medicare beneficiaries.