Managing pain in high-risk patients within a patient-centered medical home

Cheatle, Martin D.; Klocek, John; McLellan, A. Thomas

doi:10.1007/s13142-012-0113-z

Cited by 20 publications

(14 citation statements)

References 80 publications

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“…Research shows that pain is the main reason patients seek medical care, and yet medical management of patients with chronic pain and complex problems remains fragmented, leading patients to seek a wide variety of primary and specialty care services in an effort to manage their pain and related conditions [1, 2]. Such fragmented care leads to poorer outcomes and significantly increases health-care costs as patients often receive unneeded diagnostic and medical procedures [2, 3]. …”

mentioning

confidence: 99%

A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework

DeBar

Kindler

Keefe

et al. 2012

Behav. Med. Pract. Policy Res.

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Chronic pain affects at least 116 million adults in the USA and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, the primary care setting is where most patients seek and receive care for pain. Primary care-based treatment of chronic pain by interdisciplinary teams (including behavioral specialists, nurse case managers, physical therapists, and pharmacists) is one of the most effective approaches for improving outcomes and managing costs. To ensure robust integration of such services into sustainable health-care programs, evaluations must be conducted by researchers well versed in the methodologies of clinical trials, mixed methods and implementation research, bioinformatics, health services, and cost-effectiveness. Recent national health policy changes, in addition to the increasing recognition of the high prevalence and cost of chronic pain conditions, present a unique opportunity to shift the care paradigm for patients with chronic pain.

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mentioning

confidence: 99%

A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework

DeBar

Kindler

Keefe

et al. 2012

Behav. Med. Pract. Policy Res.

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“…Chronic prescription of opioids to patients with PDB is widespread in primary care. 20 Patients and providers both consider pain to be the primary issue for these patients. 7 Providers may continue prescribing opioids for pain even when they recognize PDB and acknowledge a comorbid opioid use disorder.…”

Section: Discussionmentioning

confidence: 99%

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

Grande¹,

Thompson²,

Au³

et al. 2016

The Journal of the American Board of Family Medicine

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Purpose: Problem drug-related behavior (PDB) among patients on chronic opioid therapy may reflect an opioid use disorder. This study assessed PDB prevalence and the relationship between PDB and ongoing prescription of opioids at a primary care clinic that implemented a multifaceted opioid management program.Methods: A chart review of patients in a chronic opioid registry assessed prevalence of different types of PDB over 2 years, and whether opioids were prescribed during the last 3 months of the 2-year study period among patients with different levels of PDB.Results: Among 233 registry patients, 84.1% exhibited PDB; 45.5% exhibited >3 types of PDB. At the end of 2 years, most registry patients were still prescribed opioids, though patients with >3 types of PDB were less likely than those without PDB to be prescribed opioids (62.3% vs. 78.4%, P ‫؍‬ 0.016).Conclusions: PDB was pervasive in this population of patients on chronic opioid therapy. Those with the most PDB, and thus with the greatest likelihood of opioid use disorder and its social and medical consequences, were the least likely to be prescribed opioids by the clinic after 2 years. Given the rising rates of illicit opioid use in the U.S., it is important that clinics work closely with their patients who display PDB, systematically assess them for opioid use disorder, and offer evidence-based treatment.

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“…Medical management of patients with chronic pain is fragmented, with patients seeking a wide variety of primary and specialty care services [1,3]. This fragmentation of care leads to poorer outcomes and higher health care costs as patients may receive unneeded diagnostic and medical procedures [3,4]. Many patients could benefit from multidisciplinary behaviorally-oriented approaches that emphasize pain management over a cure, and improved function over pain relief [5,6].…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) – Protocol for a pragmatic cluster randomized trial

DeBar

Benes

Bonifay

et al. 2018

Contemporary Clinical Trials

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Background Chronic pain is one of the most common, disabling, and expensive public health problems in the United States. Interdisciplinary pain management treatments that employ behavioral approaches have been successful in helping patients with chronic pain reduce symptoms and regain functioning. However, most patients lack access to such treatments. We are conducting a pragmatic clinical trial to test the hypothesis that patients who receive an interdisciplinary biopsychosocial intervention, the Pain Program for Active Coping and Training (PPACT), at their primary care clinic will have a greater reduction in pain impact in the year following than patients receiving usual care. Methods/design This is an effectiveness-implementation hybrid pragmatic clinical trial in which we randomize clusters of primary care providers and their patients with chronic pain who are on long-term opioid therapy to 1) receive an interdisciplinary behavioral intervention in conjunction with their current health care or 2) continue with current health care services. Our primary outcome is pain impact (a composite of pain intensity and pain-related interference) measured using the PEG, a validated three-item assessment. Secondary outcomes include pain-related disability, patient satisfaction, opioids dispensed and health care utilization. An economic evaluation assesses the resources and costs necessary to deliver the intervention and its cost-effectiveness compared with usual care. A formative evaluation employs mixed methods to understand the context for implementation in the participating health care systems. Discussion This trial will inform the feasibility of implementing interdisciplinary behavioral approaches to pain management in the primary care setting, potentially providing a more effective, safer, and more satisfactory alternative to opioid-based chronic pain treatment. Clinical Trials Registration Number: NCT02113592

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Managing pain in high-risk patients within a patient-centered medical home

Cited by 20 publications

References 80 publications

A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework

A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) – Protocol for a pragmatic cluster randomized trial

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