Chronic Non-Cancer Pain: A Siren for Primary Care - A Report From the PRImary care MultiEthnic Network (PRIME Net)

Leverence, Robert; Williams, Robert L.; Potter, Michael B.; Fernald, Douglas H.; Unverzagt, Mark; Pace, Wilson D.; Parnes, Bennett; Daniels, Elvan; Skipper, Betty J.; Volk, Robert J.; Brown, Anthony E.; Rhyne, Robert L.

doi:10.3122/jabfm.2011.05.110030

Cited by 49 publications

(59 citation statements)

References 28 publications

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“…6,7,10,11,21,28,30 The PCMH model aims to pro-vide comprehensive patient-centered care, and implementation of PCMHs in the primary care setting has resulted in improved adherence to guidelines and screening recommendations for common chronic disease states. 23 Although the practices in our naturally occurring study were not matched for demographics or presence of a residency practice, our study is one of the first to examine the impact of PCMH recognition on the documentation of recommended care for patients with CP.…”

Section: Discussionmentioning

confidence: 99%

“…32 Systemic barriers such as long waiting lists and lack of access to addiction, pain, and mental health specialists because insurance barriers and reimbursement policies also plague optimal CP management. 6,13 There are several limitations to this study. For convenience, we studied only a subset of the CARInG PBRN, which uses a single EHR.…”

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confidence: 99%

“…Long waits to access pain management and lack of access to addiction medicine and integrative and mental health specialists are barriers in CP management. 6,13 Reimbursement policies may limit patient-centered care, as PCPs have limited time for planning, performing comprehensive assessments, and coordinating care. 3 Further, there may be little teamwork or few structured opportunities for communication between office staff and PCPs, resulting in important information divulged by patients to staff, which is then not relayed to PCPs.…”

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confidence: 99%

“…Physicians cite past experiences with opioids and fears of regulatory scrutiny, of creating addicts, and of being "duped" by patients with CP as reasons for difficulties in caring for patients with CP. 6,31 Patients with CP often suffer from significant psychiatric comorbidities such as depression, anxiety, and substance use disorders and find engaging with treatment difficult. 6,32 Patients with CP report a lack of resources, including minimal support from family and friends and financial and transportation constraints, as further barriers to optimal pain management.…”

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confidence: 99%

“…6,31 Patients with CP often suffer from significant psychiatric comorbidities such as depression, anxiety, and substance use disorders and find engaging with treatment difficult. 6,32 Patients with CP report a lack of resources, including minimal support from family and friends and financial and transportation constraints, as further barriers to optimal pain management. 32 Systemic barriers such as long waiting lists and lack of access to addiction, pain, and mental health specialists because insurance barriers and reimbursement policies also plague optimal CP management.…”

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confidence: 99%

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Provision of Recommended Chronic Pain Assessment and Management in Primary Care: Does Patient-Centered Medical Home (PCMH) Recognition Make a Difference?

Elder

Penm

Pallerla

et al. 2016

The Journal of the American Board of Family Medicine

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Background: Chronic pain (CP) care in the patient-centered medical home (PCMH) model has not been well studied. We assessed whether PCMH recognition is associated with increased provision of key practice recommendations for CP assessment and management.Methods: Chart reviews were completed for 12 primary care practices affiliated with one health system in the Cincinnati Area Research and Improvement Group (CARInG). Recommendations were abstracted and compared based on PCMH status: 3 practices had received prior PCMH level 3 recognition, 5 were in an ongoing process of applying, and 4 had no recognition and were not applying.Results: A total of 485 charts were reviewed from 65 PCPs. Eight of 10 key recommendations were documented more often in the prior and ongoing PCMH cohorts, including assessing pain severity, function, psychosocial distress, and substance abuse, and using structured instruments for these assessments. There were fewer differences between the cohorts in the management of chronic opioids, with only the ongoing PCMH cohort having higher documentation for 5 of the 7 recommendations, including performing urine drug screens and using a structured instrument to assess for misuse. Conclusions

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Provision of Recommended Chronic Pain Assessment and Management in Primary Care: Does Patient-Centered Medical Home (PCMH) Recognition Make a Difference?

Elder

Penm

Pallerla

et al. 2016

The Journal of the American Board of Family Medicine

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Specialized Pain Clinics in Primary Care: Common Diagnoses, Referral Patterns and Clinical Outcomes – Novel Pain Management Model

Fogelman

Carmeli

Minerbi

et al. 2017

Clinical Investigation

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An estimated 19% of the adult population in western countries lives with chronic pain. Pain management lies mainly within the primary care and community setting. We evaluated the outcome of a new model of secondary care clinics, conducted by primary care physicians with specialized training in pain medicine. Data on referral patterns, prevalence of pain diagnosis, and medication consumption were recorded at five secondary pain management clinics in the community setting. In total, 997 patients with pain attended 2,652 visits (average 2.7 visits per patient) during 12 mo. Patients' age ranged from 18 to 92 yr (mean 59 ± 19). Mean pain intensity on the first visit, evaluated by the visual analogue scale was 7.7/10. Myofascial pain syndrome was the most common diagnosis (82%). Treatment included dry needling or trigger point injection (82%), manual myofascial release (23%), and pharmacotherapy (38%). Significant short-term improvement after treatment was reported by 75% of patients, and 72% reported long-term improvement. Four percent were referred to tertiary care pain clinics, 5% were referred to other specialists, and 5% to imaging. Secondary, community-based pain clinics, run by specially-trained primary physicians, demonstrated feasibility. The vast majority of patients referred to the clinics were treated using simple, inexpensive modalities, while sparing referrals to unnecessary consultation visits, imaging tests, and medications.

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Understanding how primary care clinicians make sense of chronic pain

et al. 2018

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Chronic pain leads to reduced quality of life for patients, and strains health systems worldwide. In the U.S. and some other countries, the complexities of caring for chronic pain are exacerbated by individual and public health risks associated with commonly used opioid analgesics. To help understand and improve pain care, this article uses the data-frame theory of sensemaking to explore how primary care clinicians in the U.S. manage their patients with chronic noncancer pain. We conducted Critical Decision Method interviews with 10 primary care clinicians about 30 individual patients with chronic pain. In these interviews, we identified several patient, social/ environmental, and clinician factors that influence the frames clinicians use to assess their patients and determine a pain management plan. Findings suggest significant ambiguity and uncertainty in clinical pain management decision making. Therefore, interventions to improve pain care might focus on supporting sensemaking in the context of clinical evidence rather than attempting to provide clinicians with decontextualized and/or algorithm-based decision rules. Interventions might focus on delivering convenient and easily interpreted patient and social/environmental information in the context of clinical practice guidelines.

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Chronic Non-Cancer Pain: A Siren for Primary Care - A Report From the PRImary care MultiEthnic Network (PRIME Net)

Cited by 49 publications

References 28 publications

Provision of Recommended Chronic Pain Assessment and Management in Primary Care: Does Patient-Centered Medical Home (PCMH) Recognition Make a Difference?

Provision of Recommended Chronic Pain Assessment and Management in Primary Care: Does Patient-Centered Medical Home (PCMH) Recognition Make a Difference?

Specialized Pain Clinics in Primary Care: Common Diagnoses, Referral Patterns and Clinical Outcomes – Novel Pain Management Model

Understanding how primary care clinicians make sense of chronic pain

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