November 2026

Chronic pain remains one of the most common and challenging conditions encountered in primary care. This four-part SCOPE series explores practical, evidence-based approaches to pain management that emphasize patient safety, function, and quality of life.  If you missed the earlier installments in the series, we encourage you to reference the September and October issues of SCOPE.

Introduction

"How would you rate your pain on a scale of 0 to 10?"

This question has become a routine part of clinical practice. While pain intensity is important, the answer often provides only a limited picture of a patient's overall experience.

In chronic pain management, meaningful improvement is not defined solely by lower pain scores. Success is often reflected in improved function, greater independence, enhanced participation in valued activities, and a better overall quality of life.

A patient whose pain remains at 6 out of 10 may now be sleeping through the night, walking regularly, returning to work, or participating in family activities. Another patient whose pain score decreases substantially may still struggle with daily function and quality of life.

To recognize these improvements, clinicians need measures that extend beyond pain intensity alone.

Why Pain Scores Are Not Enough

Pain is a complex biopsychosocial experience influenced by physical, psychological, and social factors. A numerical pain rating captures symptom severity at a particular moment but does not adequately reflect how pain affects daily life.

When assessing treatment success, clinicians should consider questions such as:

• Can the patient walk farther than before?
• Are they sleeping better?
• Have they returned to work or hobbies?
• Are they participating more fully in family activities?
• Has their overall quality of life improved?
• Are they functioning more independently?

Many effective interventions improve function, sleep, mood, and activity levels before producing substantial reductions in pain intensity. Focusing only on pain scores may overlook meaningful progress and reinforce unrealistic expectations that treatment should eliminate pain entirely.

Five Practical Tools for Primary Care

Numerous validated instruments exist to assess pain-related function and quality of life. The following tools are particularly useful because they can be readily integrated into routine primary care practice.

1. PEG Scale

The PEG Scale is derived from the Brief Pain Inventory and evaluates three domains:

• Pain intensity
• Interference with enjoyment of life
• Interference with general activity

Each item is rated on a 0 to 10 scale and averaged to create a total score.

The PEG is brief, easy to administer, and captures both symptom burden and functional impact. Because of its simplicity, it is particularly well suited for longitudinal monitoring in primary care.

Best use: Routine assessment at chronic pain follow-up visits.

2. Patient-Specific Functional Scale (PSFS)

The Patient-Specific Functional Scale asks patients to identify activities that have become difficult because of pain and rate their ability to perform those activities.

Examples may include:

• Walking around the neighborhood
• Gardening
• Climbing stairs
• Working a full shift
• Playing with grandchildren

The PSFS keeps treatment focused on outcomes that matter most to the individual patient and aligns naturally with functional goal setting.

Best use: Establishing and tracking individualized treatment goals.

3. Oswestry Disability Index (ODI)

For patients with chronic low back pain, the Oswestry Disability Index remains one of the most recognized and widely used functional assessment tools. The ODI evaluates the impact of pain on activities such as:

• Walking
• Sitting
• Standing
• Personal care
• Lifting
• Sleeping
• Travel
• Social participation

Many primary care clinicians will encounter ODI scores generated by physical therapists, spine specialists, orthopedic providers, and pain clinics. Familiarity with the tool can facilitate interdisciplinary communication and help track changes in disability over time.

Best use: Chronic low back pain and lumbar spine disorders.

4. PHQ-9

Depression and chronic pain frequently coexist and can negatively influence one another.

Patients with untreated depression often experience increased pain severity, greater functional impairment, and poorer treatment outcomes. Monitoring depression alongside pain-related outcomes can provide a more complete understanding of overall clinical progress.

Improvement in PHQ-9 scores may reflect meaningful gains in quality of life even when pain intensity remains relatively stable.

Best use: Patients with chronic pain who report mood symptoms, fatigue, sleep disturbances, or reduced activity.

5. Functional Goal Tracking

Not every assessment requires a formal questionnaire. At the beginning of treatment, clinicians and patients should establish specific, measurable functional goals such as:

• Walking 20 minutes three times per week
• Returning to gardening
• Attending family events
• Sleeping through the night
• Resuming exercise
• Returning to work

Progress toward these goals should be reviewed regularly. For many patients, achievement of these goals represents success more meaningfully than any numerical pain score.

Best use: Every chronic pain visit.

Other Assessment Tools

No single instrument is ideal for every patient or clinical setting. Additional tools, including the Brief Pain Inventory, PROMIS measures, Roland-Morris Disability Questionnaire, Pain Disability Index, and EQ-5D, can provide valuable information regarding disability, pain interference, and health-related quality of life.

Each tool offers unique advantages and limitations. Some provide more comprehensive assessments but require additional time or scoring and are used more frequently in specialty practices or research settings. For most primary care clinicians, selecting a small number of practical tools and applying them consistently is often more valuable than administering numerous questionnaires intermittently.

Questions That Reveal Meaningful Progress

Formal assessments are useful, but some of the most informative measures come from direct conversation.

Consider asking:

• What are you able to do now that you could not do six months ago?
• Has anything become easier since your last visit?
• How has pain affected your ability to work?
• Are you sleeping better?
• Are you exercising more?
• Have you returned to activities you enjoy?
• Are you participating more in family or community events?

These questions often reveal meaningful improvements that may not be reflected by pain intensity alone.

A Practical Workflow for Primary Care

For most practices, a streamlined approach is sufficient:

At every chronic pain visit:

• Pain score
• PEG score
• Review of functional goals

Every 3 to 6 months, or as clinically indicated:

• PHQ-9
• PSFS reassessment
• ODI for patients with chronic low back pain
• Discussion of overall function and quality of life

This approach adds minimal burden while providing a much more complete assessment of treatment effectiveness.

Reframing Success

Patients often judge treatment success primarily by changes in pain intensity. Clinicians can help broaden that perspective.

Rather than saying:

"Your pain only improved from 7 out of 10 to 6 out of 10."

Consider:

"Your pain score changed only slightly, but you are walking every day, sleeping through the night, and attending your grandchildren's activities again. Those are meaningful improvements."

This reframing reinforces realistic expectations and highlights gains that patients might otherwise overlook.

Bottom Line

Chronic pain management is about improving lives, not simply lowering pain scores.

Tools such as the PEG Scale, Patient-Specific Functional Scale, Oswestry Disability Index, PHQ-9, and structured functional goal tracking provide practical ways for primary care clinicians to measure outcomes that matter most. By incorporating these assessments into routine practice, clinicians can better recognize meaningful progress, support patient motivation, and make more informed treatment decisions.

For many patients, success is not defined by the absence of pain. It is defined by the return of function, independence, and participation in the activities that give life meaning.

Looking Ahead

The final article in this series will examine the role of opioids in chronic pain management, including appropriate patient selection, realistic expectations, risk mitigation strategies, and ongoing monitoring in the primary care setting.

Article references available upon request.

The final quarter of the year represents an opportunity to improve outcomes for our Medicare members. Two key measures that deserve concentrated attention are Statin Use in Persons with Diabetes (SUPD) and Medication Adherence.

Statin Use in Persons with Diabetes (SUPD)

Patients with diabetes are at significantly increased risk for cardiovascular disease. The SUPD measure evaluates the percentage of members ages 40-75 with diabetes who receive statin therapy during the measurement year. Members who have at least two diabetes medication fills and receive at least one statin fill during the year meet the measure.

Q4 Action Steps and Opportunities

• Identify patients with diabetes or newly diagnosed patients, aged 40-75, who are not currently prescribed a statin. 
• Consider the cardiovascular benefits of statin therapy, even when cholesterol levels appear controlled.
• Address reported side effects from patients with prescription lapses by considering alternative statins or dosage adjustments.

Medication Adherence

Medication adherence measures, strongly associated with better clinical outcomes, evaluate whether members maintain at least 80% proportion of days covered (PDC) for:

• Diabetes medications
• Renin-Angiotensin System (RAS) Antagonists for hypertension
• Statins for cholesterol management

Q4 Action Steps

• Identify patients with delayed or overdue refills. Discuss potential barriers such as medication cost, transportation, forgetfulness, or side effects.
• Talk about mail-order pharmacy services or delivery options if picking up prescriptions is a barrier.
• Prescribe 90- or 100-day supplies when clinically appropriate.

Questions to Ask Patients

• Have you missed any doses in the last month?
• Have you experienced side effects or concerns with your medication?
• Do you have enough medication to last until your next refill?
• Would a 90-day supply make it easier to stay on therapy?

The Q4 Opportunity

The weeks remaining in the year provide a critical window to close care gaps. Provider outreach, medication reviews, and timely prescription renewals remain some of the most effective strategies for improving both SUPD and Medication Adherence measures.

Together, we can help members stay healthy, prevent cardiovascular events, and finish the year strong.

There is often a misconception about who is most affected by COPD. Often people think COPD is most likely to affect older adults; however, anyone can develop COPD. While cigarette smoking is the leading risk factor for COPD, one in four people who develop COPD have never smoked cigarettes.

Independent Health has updated its Medicare Advantage plan offerings for 2027 and its RedShirt experts are available to help individuals review their options during the Medicare Annual Enrollment Period that began on October 15. 

Federal law H.R.1 (known as the “One Big Beautiful Bill” Act) has put in place work requirements for Medicaid beneficiaries.  

Independent Health develops outreach campaigns to members in need of certain preventive services and to help make them aware of our programs and resources to help them maintain or improve their health. Here is a summary of the current outreach campaigns underway. 

Participating providers are required to follow Independent Health policies and procedures when referring members to non-contracted providers.

Before referring a member for non-emergent out-of-network services you must:

• Coordinate with Independent Health and obtain authorization as required.
• Confirm that the requested service is medically necessary and covered by Independent Health.
• Follow applicable requirements for out-of-area, out-of-network requests.

Failure to obtain required authorization for non-emergent out-of-network services may result in a financial sanction to the participating provider, as outlined in the Independent Health Provider Financial Sanction Policy (M20160226008).

For requirements related to out-of-area, out-of-network authorization requests, refer to the Out of Network Requests for Authorization Policy (M850101075). 

Both policies are available in the secure provider portal.

Effective January 1, 2027, FreeStyle Libre systems from Abbott will become the preferred brand of continuous glucose monitors (CGMs) for Medicare members. This coverage change went into effect for commercial and Essential plan members on July 1, 2026.

If you are a provider who has Medicare patients currently using a Dexcom CGM, you may have already received a letter from us with more details, including a patient list.

The FreeStyle Libre 2 Plus and Libre 3 Plus systems are already covered, so patients can begin switching immediately.

Medicare members who are affected by this change have been sent a letter with instructions to call their doctor for assistance in choosing a new FreeStyle system. Patients who use insulin pumps must ensure the new CGM is compatible with their pump. (We do not anticipate many compatibility issues.)

Our goal is to continue providing quality, access, and value as healthcare costs continue to rise. Moving to the FreeStyle brand of CGMs provides significant cost savings while continuing to provide appropriate, high-quality products to manage diabetes. 

As always, if you have any questions, please contact Provider Relations. Thank you for your continued partnership. 

Remember to view our up-to-date policies online. 

Drug Formulary Changes

View the formulary deletions, effective November 1, 2026: 

• Medicare Advantage formulary deletions for the Individual Standard formulary
• Medicare Advantage formulary deletions for the Individual Enhanced & Group formularies
• Pharmacy Benefit Dimensions 3-Tier formulary deletions
• Pharmacy Benefit Dimensions 5-Tier formulary deletions

Access Independent Health's drug formularies here.

Drug Policy Changes

Search for and view the most current versions of all Independent Health’s drug policies when logged in to our provider portal.

Prime Therapeutics reviews prior authorizations for select oncology and specialty drugs on Independent Health’s behalf. Log in to view Prime Therapeutics policies for the drugs it reviews.

To obtain a hard copy, please contact Independent Health Provider Relations by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 5 p.m.

Independent Health earns designation as a 4.5 Star Rated Medicare Plan for 2027: Oct. 15, 2026.