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Cognitive Behavioral Therapy for Pain ManagementAccording to the National Institutes of Health, more Americans suffer from chronic pain than diabetes, heart disease and cancer combined, making them dependent on or addicted to opioid painkillers. The treatment of patients with chronic pain is difficult and challenging as also revenue cycle management, leading most providers to rely on outsourced medical billing and coding services. A recent study focused on examining the benefits of a new form of cognitive behavioral therapy for pain management. The findings of this study are significant given that the focus is shifting to non-pharmacological therapies for pain management.

A team of researchers from King’s College London (KCL) in the United Kingdom studied the benefits of a new form of CBT – called “acceptance and commitment therapy” (ACT) – on the functioning and well-being of patients with chronic pain. Their study was published recently the Journal of Pain.

ACT is based on the psychological flexibility model, which includes a therapeutic process known as “self-as-context” (SAC). The ACT approach to pain management is based on the psychological flexibility model and focuses on building effective patterns of behavior change rather than symptom reduction. This particular form of CBT is used to treat a variety of psychological problems ranging from addiction to coping with disabilities.

The subjects of the study were 412 adults who were referred to a pain management center in London. They completed measures of treatment processes, such as SAC and committed action, and outcomes (pain-related interference, work and social adjustment, depression) before treatment, upon treatment completion and after nine months. The researchers found that:

  • ACT-oriented treatment was associated with improved SAC as well as improved functioning
  • Changes in SAC were associated with changes in pain-related interference, work and social adjustment and depression.
  • ACT-oriented treatment promoted greater psychological flexibility and was associated with less pain-related anxiety and avoidance, less depression, less physical and psycho-social disability and other measures of patient function.
  • Scores from both the process and outcomes measures significantly improved after treatment and were maintained at nine-month follow-up.

Cognitive Behavioral Therapy for Pain Management“Based on studies of forms of CBT that did not include ACT, acceptance of pain, one component of psychological flexibility, may be a general mechanism by which CBT treatments achieve improvements in functioning, and more specific targeting of pain-related acceptance may lead to further improvement is CBT outcomes,” noted the co-author of the study.

Given that payers are increasingly denying reimbursement for even routine interventional pain procedures, this new form of cognitive behavioral therapy for pain management could have great relevance. In fact, the Center for Disease Management and Control (CDC), and new guidelines from the American College of Physicians support the addition of alternative, non-pharmacologic methods of pain treatment.

As they deal with the complexities of managing patients with chronic pain, providers need to have a solid medical billing strategy in place. Payer policies on notifications, coverage and reimbursement have changed drastically over the past few years. Some of the recent changes are:

  • Physicians are being required by payers to obtain pre-authorizations prior to providing the procedures
  • Procedures are only approved if providers can show sufficient proof that services are required and other conservative therapies have failed
  • Payers have specific guidelines and limitations regarding how many times the physicians can perform the procedures
  • There are more controls on prescribing combinations of drugs and complex drugs
  • Post-service, prepayment coding reviews have also become commonplace.

The support of an experienced medical billing company can be invaluable to help pain management physicians get paid successfully. Reliable companies have well-educated coders who are knowledgeable about anatomy and know how to assign the right codes for procedures performed. Their insight can help physicians maintain accurate and complete documentation. They are also up-to-date on payer policies and guidelines.

Physicians should also be open to exploring new non-pharmacologic treatment options, including physical therapy and behavioral health to enhance and extend their core business.