Chronic pain management

Friday, May 20, 2016 10:46 AM

ACC Chronic Pain Management Program: A clinician’s experience

by Kenneth Soda, MD, Chief Medical Officer, Colorado Community Health Alliance, RCCO#6

An epidemic of inappropriate opioid use in the United States for non-cancer related chronic pain syndromes has captured much attention lately. Medicaid-insured patients represent a challenging population in addressing this health care issue. They and their primary care medical providers (PCMPs) face a lack of access to specialty care providers and social determinants of health resources. These factors can impact success in decreasing dependence on opioid utilization for pain.

However, providers from 42 practices across the state had a unique opportunity last year to participate in Project ECHO Pain through the Colorado Accountable Care Collaborative. Developed by The Weitzman Institute, the research and innovation arm of the Community Health Center Inc. (CHC), Project ECHO is a HIPAA-compliant teleconferencing program that connects PCMPs to pain management specialists. Through Project ECHO, the Colorado PCMPs engaged directly with specialists in a real-time online video conferencing system. They consulted directly with an interdisciplinary team regarding client cases and learned best practices with a variety of chronic pain conditions.

While participating, PCMPs like me were provided with an intelligent and integrative approach to addressing the needs of Medicaid patients with perplexing and multifactorial complex pain syndromes. Twice a month, we shared patient cases with a panel of experts from various backgrounds in medicine, pharmacology, behavioral health, social work, alternative and integrative care medicine. A follow-up presentation on topics such as psychosocial approaches to pain management, acupuncture therapy, addressing opioid addiction and pain medication tapers augmented the latest in clinical data supporting medical providers’ approach to caring for these patients. A link to other medical providers in the state through a “chat” feature was a valuable tool for sharing challenges, successes and community resources with colleagues in Colorado.

I valued the advice and direction from the panel of experts on the team at Project ECHO Pain. It had a profound impact on the approach to chronic pain related syndromes encountered with my patients. It validated my concerns and permitted me to reassess the strategies and resources currently available to helping my patients. Although success varied among patients, I gained greater confidence in compassionately and honestly addressing my patients’ chronic pain concerns.

I encourage other primary care medical providers to renew efforts in addressing this crucial clinical issue facing our practices today. Project ECHO is a good place to start.

Of course, monitoring our success is important. We should be vigilant in reviewing patient clinical performance in achieving the goals of improved outcomes for pain management. Hopefully, this will be seen in the reduction of opiate utilization, improved quality of life indicators for patients, and a reduction in intentional and unintentional opiate overdoses.

Note:
Project ECHO Pain and Project ECHO Buprenorphine are available at no cost to Colorado Medicaid PCPs through the sponsorship of the Colorado Department of Health Care Policy and Financing.

• Project ECHO Pain connects primary care providers with chronic pain specialists to learn more holistic, multi-disciplinary approaches to treating chronic pain and to reduce the need for prescribing opioids. The sessions are provided twice monthly for one year. Participants and staff members from participating sites also receive access to PainNET, an online resource where staff can access pain care tools, news and blogs, and collaborate with experts and peers.
• Project ECHO Buprenorphine links providers with specialists on buprenorphine treatment and counseling, providing them with the support and expert advice that they need to gain confidence in their management of opioid dependence with buprenorphine. The sessions are provided once a month for one year.

For more information about participation in Project ECHO Pain or Project ECHO Buprenorphine, contact Agi Erickson, director of Project ECHO, at 860-347-6971x3741or Agi@chc1.com.