Featured Articles: Pain Management/Opioids

Pain Management: Complex Chronic Non-cancer Pain - Region X Moves Forward

Sunday, December 15, 2013   (0 Comments)
Posted by: Joy Ingram
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by Lynn Gerlach, Development and Communication Manager

2014 will bring several outstanding opportunities for NWRPCA member health centers to assess and improve their approach to pain management. After 18 months of consistent efforts to understand and address the needs of members around opioid prescribing and other approaches to pain management, NWRPCA is now poised to take more focused, purposeful action on behalf of its members.

Plans for 2014 include 9 hours of intensive training in Seattle May 17 and 18 as part of the annual Spring Primary Care Conference, additional conference-related training in Denver (with CHAMPS) in October, and possibly a “pain management summit” in conjunction with Group Health Research Institute and the MacColl Center for Healthcare Innovation. NWRPCA has also been partnering with the University of Washington and Swedish Family Medicine Residency.

Recently the regional PCA conducted a 10-question survey meant to discover the current status of CHCs’ approaches to this challenging issue and to determine at the same time exactly what type of assistance Region X providers would prefer. 245 providers in Alaska, Idaho, Oregon and Washington were invited to participate. To date 25% have responded; the survey will remain open until the end of 2013. (If you are a provider at a Region X health center and were not asked to participate, emaillgerlach@nwrpca.org for a link to the survey.)

The 54 individuals who had responded when this article was posted represented nearly half of NWRPCA’s 81 health center members. Responses by state almost exactly replicate NWRPCA’s membership:

  • Alaska: 25% of NWRPCA members – 25% of respondents
  • Idaho: 14% of NWRPCA members – 11% of respondents
  • Oregon: 31% of NWRPCA members – 32% of respondents
  • Washington: 31% of NWRPCA members – 32% of respondents

All respondents are in clinical jobs, including 40% medical directors, 18% physicians, 18% physician assistants, 14% ARNPs, 10% behavioral health providers, ad 11% “other.” 35% have been at their CHC for more than 10 years; 26% have worked there for 6-10 years; 24% have been there for 2-5 years, and 15% have been at that CHC for less than 2 years.

Asked to select the statement that most accurately describes their health center’s pain management approach, 35% selected the “multi-modal” descriptor. 33% indicated they prescribe opioids and have also tried a few complementary approaches. 25% indicate they prescribe opioids for chronic pain (but do not use other approaches). 6% say they simply do not treat complex chronic non-cancer pain. And 2% say they do treat complex pain patients but not with prescription opioids.

37 clinicians who described their pain management programs as “multi-modal” specified the modalities used as follows:

  • 100% prescribe NSAIDs
  • 95% prescribe opioids
  • 86% have integrated behavioral health
  • 78% use physical and/or occupational therapy referral and follow-up
  • 49% use rehab and cognitive behavioral approaches
  • 46% use complementary or “alternative” medicine such as exercise or acupuncture

How satisfied are respondents with their current pain management programs? 64% are somewhat satisfied. 21% are dissatisfied. 11% are very satisfied; 4% say they have an outstanding program and can share best practices. In early January 2014 NWRPCA will report which best practices members suggest they would be willing to share with their peers.

Even within any particular health center, including those with formal pain management protocols, not all providers understand or interpret the program in a uniform way. Fourteen CHCs submitted responses from more than one provider. Of those, the respondents of only one CHC had a fully consistent description of exactly what the health center’s approach to pain management is. In all other cases, one provider indicated “we have a multi-modal approach” and his/her colleague(s) chose a different descriptor for their program.

If should probably come as no surprise that, of the 14 CHCs that sent multiple responses by multiple providers, 9 (65%) had providers with differing levels of satisfaction in the current pain management program. In one CHC, three different providers actually reported three different levels of satisfaction: One rated his/her program as “outstanding – with best practices to share”; another selected “very satisfied”; the third selected “somewhat satisfied.” It is probably not surprising that healthcare providers working in the same ambulatory clinic describe their pain management program differently and have differing feelings about how successful it is.

We offered respondents 12 practical guidelines or best practices in pain management as potential topics for future training and asked them how helpful they believe each would be as a training topic. After the survey is completed in late December, NWRPCA will report the final results. In the interim, we can report that eight of the 12 topics have, so far, been overwhelmingly rated as either “extremely helpful” or “quite helpful.” The practice most enthusiastically chosen as a desirable training topic to date was “alternative approaches & resources for complex chronic pain management (e.g. activation, relaxation, changing dysfunctional thoughts).”

NWRPCA staff will continue to collect responses and analyze the results of the survey, using that data to inform plans for the “pain management/safe opioid prescribing” sessions for the Seattle conference in May. Clinicians are encouraged to respond through the month of December if they have not yet done so. In addition, any clinician, clinic manager or other Region X CHC leader directly affected by this issue should feel free to volunteer to help plan those sessions. Contact Lynn Gerlach at 206-783-3004 x12 or lgerlach@nwrpca.org.

NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.


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