Pain Clinical Module 1: Integrated Approach to Pain Using First-Line Treatments
Goal:

Healthcare clinicians in training will be able to choose the most appropriate first line pharmacological and non-pharmacological therapy for common pain conditions based upon a complete pain assessment. They will learn to collaborate and communicate with colleagues to use an integrated approach to multidisciplinary pain treatment.

: 0.75 hrs

After completing this activity participants will be able to:

  • Take a systematic approach to pain history, assessment, and diagnosis

  • Describe the main pharmacological and non-pharmacological categories of pain treatments

  • Choose the most appropriate category of treatment for a patient with acute or chronic pain conditions

  • Follow first line best practice guidelines for common chronic pain conditions

  • Collaborate with colleagues in a multidisciplinary approach to pain management with a medical “home”


Professional Practice GapsThe recent guidelines produced by the American Pain Society (APS) and the American Association of Pain Medicine (AAPM), Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain (Chou et al., 2009), recommended multidisciplinary care for pain and that when opioids are prescribed for a patient with chronic pain, a single clinician should be identified who is primarily responsibility for the patient's overall medical care (Chou, et al., 2009). However, multidisciplinary pain centers have decreased in number and are not an option for most patients in chronic pain (AHRQ, 2007). Individual pain providers thus now need to coordinate care among themselves to provide the same multidisciplinary care in multiple settings. A survey of physicians found that they do not feel they have time to consult with other providers regarding their patients being treated for chronic pain (Jamison et al, 2002). Training in coordinating pain care and improved communications among pain providers is likely to lead to more efficient consulting, which will help address the barrier of not enough time. In a needs analysis survey for developing this training program, 18 physicians and nurse practitioners surveyed rated strong agreement (mean=4.4/5) that they would be interested in CME on the topic: "Patient co-management by primary care and specialists" (CTI, 2008). In fact, this topic was rated second highest of nine topics to potentially be covered on this website, after "best practice in using opioids." This suggests that providers may not feel well prepared to fulfill the role of "home" clinician for patients with chronic pain. References
Clinical guidelines for the use of chronic opioid therapy for chronic noncancer pain. J of Pain. 2009; 10(2): 113-130.
Disease management for chronic pain: barriers of program implementation with primary care physicians. Pain Medicine. 2002; 3(2): 92-101.
Technical Brief: Multidisciplinary pain programs for chronic non-caner pain. Effective Health Care Programs. Research Protocols. 2010. Available at: http://www.effectivehealthcare.ahrq.gov
Web Based Training [in Addiction Medicine] for Pain Management Providers Needs Analysis. Unpublished Data. 2008.