Managing Chronic Pain in Primary Care: It Really Does Take a Village

Abstract

Some healthcare systems are relieving primary care providers (PCPs) of "the burden" of managing chronic pain and opioid prescribing, instead offloading chronic pain management to pain specialists. Last year the Centers for Disease Control and Prevention recommended a biopsychosocial approach to pain management that discourages opioid use and promotes exercise therapy, cognitive behavioral therapy and non-opioid medications as first-line patient-centered, multi-modal treatments best delivered by an interdisciplinary team. In the private sector, interdisciplinary pain management services are challenging to assemble, separate from primary care and not typically reimbursed. In contrast, in a fully integrated health care system like the Veterans Health Administration (VHA), interdisciplinary clinics already exist, and one such clinic, the Integrated Pain Team (IPT) clinic, integrates and co-locates pain-trained PCPs, a psychologist and a pharmacist in primary care. The IPT clinic has demonstrated significant success in opioid risk reduction. Unfortunately, proposed legislation threatens to dismantle aspects of the VA such that these interdisciplinary services may be eliminated. This Perspective explains why it is critical not only to maintain interdisciplinary pain services in VHA, but also to consider disseminating this model to other health care systems in order to implement patient-centered, guideline-concordant care more broadly.

10 kHz spinal cord stimulation: a retrospective analysis of real-world data from a community-based, interdisciplinary pain facility

“…Our results also demonstrated a statistically significant difference in opioid reduction in the SCS+ CMM group compared with those undergoing CMM only, a finding of particular importance given the increased emphasis on reducing opioid prescribing in the US as reflected in current Centers for Disease Control and Prevention guidelines. 42 An interdisciplinary approach to pain management can facilitate efforts at opioid reduction as reported in a recent Veterans Health Administration study 43 and may help to explain the reduced opioid dosing observed in the SCS+ CMM group. However, the absence of similar dose reductions in the CMM group suggests a beneficial effect of 10 kHz SCS treatment beyond that derived from the model of care.…”

Research-to-Practice Gaps in Multiple Sclerosis Care for Patients with Subjective Cognitive, Mental Health, and Psychosocial Concerns in a Canadian Center

“…32 Interdisciplinary services reduce demand on overburdened neurologists and nurses. 32 Such a care team is efficacious in other areas (eg, chronic pain, 43 stroke, 44 Parkinson disease 45 ), improving care and quality of life for patients and families. 45 Interdisciplinary MS care centers are more likely to use validated screening measures and offer treatment for psychological concerns.…”

Training primary care providers in opioid deprescribing and chronic pain management based on local guidance: a pre–post study of attitude change

“…Therefore, the challenge remains to organise and deliver integrated interventions in primary care through which most ongoing management of complex and chronic conditions occurs. To deliver integrated interventions in primary care, it is necessary to enhance the capacity of general practitioners (GPs) and affiliated teams of multidisciplinary healthcare providers (MHCPs) to deliver regimes similar to specialist units (Foster & Mitchell 2013;Hegney et al 2013;Seal et al 2017). To address this gap, we developed a Medicare-funded primary care pilot intervention called Assess, Inform, Manage and Monitor (AIMM).…”