Background Musculoskeletal (MSK) pain is common in people living with HIV (PLWH). Healthcare providers sometimes prescribe opioids to control pain, which may lead to opioid misuse. An interdisciplinary approach that includes physical therapy has been successful in managing MSK pain in various healthcare settings. Therefore, we sought to find the impact of recruiting a physical therapist (PT), on the number of opioid prescriptions and physical therapy referrals made by physicians in training to manage MSK pain in PLWH. Methods We performed a retrospective chart review of patients seen by Internal Medicine physicians in training in an HIV clinic in Detroit, before (2017) and after (2018) recruiting a PT to the healthcare team, and collected demographic and clinical data. We also surveyed the trainees to assess how the PT addition influenced their learning. IRB waiver was obtained. Results Results showed that of all PLWH seen at the clinic, 28/249 (11%) and 37/178 (21%) had chronic MSK pain in the 2017 and 2018 datasets, respectively. In 2017, all 28 patients with MSK pain were prescribed opioids. This decreased in 2018 after the PT addition (10/37 patients; p<0.0001). The number of physical therapy referrals significantly increased after the PT addition (2017: 5/28 patients; 2018: 17/37 patients; p=0.03). Trainees felt that the PT helped improve their examination skills and develop a treatment plan for patients. Conclusions The addition of a PT encouraged physicians in training to utilize non-opioid management of MSK pain in PLWH, and enhanced their learning experience, as perceived by the trainees.
Background Chronic pain in HIV infected patients is common in the ambulatory setting, the majority of which is musculoskeletal (MSK). Addressing patient’s pain is essential but physicians often fail to adequately manage MSK pain. Additionally, HIV patients with chronic non-cancer pain (CNCP) have a 2-fold increase in the risk of opioid misuse compared with the general population. We sought to determine the extent of pain complaints and opioid prescriptions in our HIV clinic as well as assess the comfort and ability of our residents to develop a comprehensive pain management plan.Methods We performed a chart review of all patients seen by our Internal Medicine (IM) residents in the HIV primary care in Detroit, MI from 01/2017-05/2017 and collected demographic and pain-related data. We also surveyed IM residents assigned to HIV primary care clinic on their knowledge and comfort developing management plans for CNCP. IRB waiver was obtained.ResultsA total of 249 HIV infected patients were seen from January 2017 to May 2017. Forty-one of 249 (16%) of patients were identified as a having CNCP and of these patients, all were treated with opioids. MSK symptoms encompassed 28/41 (68%) of the total complaints. This included back pain (n = 20), lower extremity pain (n = 10), and upper extremity pain (n = 2). Only 5/41 (17%) patients were prescribed physical therapy for their pain complaints. Fifteen of 20 (75%) of IM residents responded to a survey on their comfort and knowledge in treating CNCP. None of the 15 (0%) felt completely comfortable developing a plan for CNCP, 2/15 (13%) felt their examination skills were adequate in assessing MSK symptoms in patients with CNCp. 12/15 (80%) felt working in collaboration with a physical therapist (PT) would be beneficial in developing effective treatment plans and 10/15 (67%) thought working in collaboration with a PT would help further develop their examination skills.Conclusion A survey of our IM residents has found gaps in both knowledge and comfort in CNCP pain management and high levels of opioid prescriptions in our HIV primary care clinic. Here we provide evidence that IM residents require additional training in treating CNCP in HIV patients and are interested in multidisciplinary approaches to development of non-pharmacologic treatment plans for HIV infected patients with CNCP.Disclosures All authors: No reported disclosures.
Background Musculoskeletal (MSK) pain is common in HIV patients in the ambulatory setting. Healthcare providers tend to prescribe opioids to control MSK pain in HIV patients, which increases the risk of opioid misuse. An interdisciplinary approach that includes physical therapy has been successful in managing MSK pain in various healthcare settings. Therefore, we sought to find the impact of recruiting a physical therapist (PT), on the number of opioid prescriptions and physical therapy referrals made by resident physicians to manage MSK pain in HIV patients. Methods We performed a retrospective chart review of all patients seen by Internal Medicine (IM) residents in an HIV clinic in Detroit, before (01/17-05/17; 2017 dataset) and after (01/18-05/18; 2018 dataset) recruiting a physical therapist to the healthcare team. We collected demographic and clinical data from both datasets. We also surveyed the residents to assess how the PT addition influenced their comfort and knowledge in treating MSK pain in HIV patients. IRB waiver was obtained. Results Results showed that of all HIV patients seen at the clinic, 28/249 (11%) and 37/178 (21%) had chronic MSK pain in the 2017 and 2018 datasets, respectively. In 2017, all 28 patients with MSK pain were prescribed opioids. This number significantly decreased in 2018 after the PT addition (10/37 patients; p< 0.0001). Moreover, the number of physical therapy referrals made by residents significantly increased after the PT addition (2017: 5/28 patients; 2018: 17/37 patients; p=0.03). Residents also recommended non-opioid interventions including orthopedics referrals (7/37 patients), braces/orthotics (3/37 patients) and non-opioid analgesics (26/37 patients) to patients after the PT addition. Survey responses showed that 7/9 residents (78%) felt that the physical therapist was helpful in improving their examination skills or developing a treatment plan for patients. The effect of recruiting a physical therapist on the number of opioid prescriptions and physical therapy referrals made by resident physicians Conclusion In conclusion, our results show that the addition of a physical therapist to the team encourages physicians to utilize non-opioid management of MSK pain in HIV patients. We also find that physicians are satisfied with taking an interdisciplinary approach to pain management in HIV patients. Disclosures All Authors: No reported disclosures
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