Innovations In Clinical Neuroscience

Hot Topics in Pain Management October 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Hot Topics in Pain Management [October 2017] 15 pathology, psychiatry, nursing, education, pharmacy, chiropractic groups, bioethics, and various state and federal agencies that studied Kansas healthcare provider and Kansas healthcare-related agency concerns regarding the assessment and management of chronic pain. This assessment revealed almost unanimous concern regarding the need for pain management education. A comprehensive, statewide, multi- year, multi-tiered collaboration aimed at improving practice performance for the assessment and management of chronic pain was developed. The program envisioned an inaugural statewide foundational conference followed by 1- to 2-day primary care intensives and quality/ performance improvement (QI) projects at the practice level. The first phase of the plan was completed with a conference in Wichita, Kansas, in November 2014. Attendance was excellent, with a diverse group of 265 healthcare providers. The conference utilized patient interviews, discussions, role play, video vignettes, and case presentations. Ninety-five percent of the attendees strongly agreed that course objectives were met. The group is now focused on planning the next stages of pain education in the form of intensives in two additional areas in the state of Kansas. The intensives will include recruitment of primary care practices in the target areas, a lecture program reviewing the foundational elements of pain assessment and management, and the development of online modules for pain-related quality improvement projects at the practice level. 9 PROJECT ECHO KANSAS Chronic pain is a complex disease. Patients suffering from pain need access to specialty care and education for this complex health condition. Unfortunately, there are not enough specialists in the field of pain management to provide care for everyone who suffers from pain, especially in rural and underserved communities. Project ECHO is a learning and guided practice model that seeks to empower and educate providers in remote areas through a hub-and-spoke knowledge-sharing network led by experts through multi-point videoconferencing. 10 Many different versions of project ECHO exist around the country and focus on various chronic diseases, one of which is chronic pain. The Kansas Project ECHO for chronic pain is in the pilot stage. The goal is to reach a select group of primary care practices scattered across the state and utilize the ECHO model to enhance practice knowledge of the assessment and management of chronic pain, provide teleconference access to experts in the field, and to assist them in developing staged quality improvement projects to achieve the aims of improvement in the management of the patient in pain. CONCLUSION Pain is one of the most common reasons for seeking medical care. Many Kansans will experience pain during the course of their lives; some will go on to develop chronic debilitating pain. The appropriate use of opioids will likely continue to be a widely used modality along a spectrum of other treatment options ranging from self-management techniques, other pharmacological agents, functional and psychological rehabilitation, various surgical and minimally invasive interventions, and complementary and alternative options to advanced pain techniques. While the national pain strategy aims to shed more light on the public health crisis of pain as a disease, the CDC guidelines might result in the unanticipated consequence of reduced access to primary care providers who are willing to explore appropriate opioid therapy for the right patient at the right time for the right reasons after other modalities have been considered and patient and provider goals have been discussed. Thus patients might find themselves caught between a rock and a hard place. Those who had been able to maintain meaningful lives through the responsible use of opioids, after exhaustion of other options, are being tapered off their medications or encouraged to find another provider willing to take over these prescriptions. It is through the education of patients, providers, and healthcare organizations that we will be able to better navigate the turbulent waters of the recognition of pain as a complex biopsychosocial disease requiring the appropriate treatment. This task will include balancing the appropriate utilization of opioids, when and if necessary, to curb and ultimately eliminate fatalities related to overdoses of this class of medication. ACKNOWLEDGEMENTS The authors would like to acknowledge the work of the Kansas Partnership for Pain Management Expert Panel and Project ECHO Kansas Steering Group for their dedication to improving pain management education across the region. The authors also acknowledge Walter Orr, MPH, and Angie Ballew, DC, MS, for their assistance in manuscript review and submission. REFERENCES 1. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770. 2. Buchbinder R, Blyth FM, March LM, et al. Placing the global burden of low back pain in context. Best Pract Res Clin Rheumatol. 2013;27(5):575–89. 3. Dzau VJ, Pizzo PA. Relieving pain in America: insights from an Institute of Medicine committee. JAMA. 2014;312(15):1507–8. 4. Centers for Disease Control. Retrieved from CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. http://wonder. cdc.gov/. 5. Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012. NCHS Data Brief. 2015;(189):1–8. 6. Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction. 2010;105(10):1776–82. 7. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315(15):1624–45. 8. National Pain Strategy. Available from: https://iprcc.nih.gov/docs/ drafthhsnationalpainstrategy.pdf. 9. Khan TW. A statewide initiative to improve the management of chronic pain: The Kansas partnership for pain management. American Academy of Pain Medicine Annual Meeting Palm Springs, CA. 2016. 10. Project ECHO. http://echo.unm.edu/

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