If You Build It, They Will Come! Pain Management Programs Fill Unmet Need

At Sg2, we continually hear about the challenges health care providers face as they address chronic pain management in their communities. The amplitude of the impact is astounding, with the cost of chronic pain estimated as high as $635 billion per year and impacting almost one-third of the US population. As if this is not troubling enough, historical interventions using opioids have not only been unsuccessful in slowing the prevalence of chronic pain, but are contributing to an even bigger problem, with more than 165,000 people dying from prescription opioid use from 1999 to 2014.

Scrutiny of surgical interventions and a shift to payment models that emphasize managing broad population health will drive substantial need for pain management over the next decade. For organizations committed to meeting the need of this typically underserved population, there is a silver lining. Governmental agencies have offered treatment guidelines, portals to track opioid utilization and, in some cases, even funding to fight chronic pain. The American Academy of Pain Medicine has published state legislative updates highlighting recent activity in this arena.

Additionally, virtual health technologies have helped to support virtual patient-to-provider consultations, provider-to-provider consultations, and continuing medical education to maximize workforce efficiencies and patient engagement to prevent and manage chronic pain.

One of the most challenging elements to building a pain program is defining the target population. Sg2 Ambulatory Market Strategist data demonstrate that, although these programs often focus on patients with spine injuries and other musculoskeletal disorders, conditions such as neuropathy and headache disorders are also commonly addressed.

CASE STUDY: RIC Employs a Multidisciplinary Team, Cognitive Behavioral Approach
The Rehabilitation Institute of Chicago (RIC) has risen to the challenge of successfully implementing a well-defined chronic pain program. Keys to their success include their unique multifaceted approach, workforce maximization, and the integration of cognitive behavioral therapy into their arsenal of tools to battle this epidemic.

The 35+-year-old Center for Pain Management, named a Center of Excellence by the American Pain Society in 2009, employs a functional restoration model that incorporates noninvasive interventions. The program is supported by an interdisciplinary team led by physiatrists that includes pain psychologists, nursing, vocational rehabilitation counselors, physical and occupational therapists, biofeedback therapists, and clinical researchers.

Complex Patients Are Commonplace in RIC’s Pain Program
Program enrollees are complex patients with chronic pain that has not been alleviated by typical treatment such as medication, physical therapy, injections and, often, even surgery.

  • Most of these patients have been through several cycles of traditional care that have failed.
  • Commonly treated conditions include chronic low back pain, chronic neck pain, complex regional pain syndrome (CRPS), myofascial pain syndrome (MPS), fibromyalgia, postsurgical pain, neuropathy, radiculopathy, neurological syndromes, and headache/migraine (HA).
  • RIC treats both adults and adolescent patients.
  • Most patients who enter the pain program are referred by their primary care practitioner or a specialist, such as an orthopedic surgeon. Ideally, early intervention allows patients to avoid costly and lingering periods of treatment before returning to work or daily activities.
  • Most participants are referred locally. However, there is a growing number of patients who attend the program from outside the local area through regional and even national referrals.
  • Participants are typically covered by commercial coverage or workers’ compensation plans.

Key Program Components Include Education and Long-term Follow-up
RIC’s goal is to develop customized, long-term strategies to manage pain and maintain a healthy, balanced lifestyle. Patients are able to return to daily occupational and leisure activities and learn techniques to diminish the emotional and psychological consequences of coping with chronic pain.

  • The program begins with a comprehensive evaluation with both a physiatrist and a psychologist.
  • Both full-day and partial-day programs are available, depending on the recommendations of the evaluating team.
  • The program includes training and education in areas such as sleep modification, body mechanics, posture, pacing, stretching and strengthening programs, mindfulness techniques, cognitive behavioral therapy, and relaxation techniques. Therapy is provided in both individual and group formats.
  • The pain physiatrist regularly monitors and adjusts all medications while a participant is involved in the program (often reducing opioid use) and focuses on mood and sleep assistance.
  • Patients with identified addiction issues are sent to a nearby behavioral health hospital and enrolled in a rapid detox program before beginning the program.
  • After “graduation” from the 6-week intensive program, patients are expected to continue to use the strategies learned in the program and then return in 1 month for a recheck with the team. If additional treatment is needed in any discipline, it is ordered at that time. The patient continues to follow up with their physician at 3, 6 and 12 months, and for as long as needed after that time.
  • Ongoing medication management visits are determined by the type and doses of medications utilized.

RIC Patients Demonstrate Decreased Pain and Opioid Use, Increased Function

  • Based on collected outcomes data, participants demonstrated overall improvement in the following areas: mood, physical function, sleep, coping with pain and pain levels themselves.
  • 73% of injured workers who entered the program over the past 2 years using opioids discontinued or decreased their opioid use.
  • 98% of patients seen in the program or physician clinic would recommend RIC services to others.

Keys to a Successful Pain Program
Feel inspired by RIC’s success? To get started with your own chronic pain program, consider the following strategies for success.

  • Leverage a multidisciplinary team. Similar to RIC’s approach, Sg2 recommends a full complement of providers operating at the top of their licenses. Typically led by a physiatrist or pain anesthesiologist, teams can include addiction specialists, nurse practitioners or physician assistants, physical and behavioral therapists and pharmacists.
  • Address concerns regarding opioid use. Include screening tools in the triage process to identify at-risk patients. Collaborate with local addiction programs to address possible misuse of opioids and modification of pharmaceutical interventions.
  • Incorporate ongoing education and long-term follow-up into your pain program. By teaching self-coping skills and scheduling regular check-ins with patient graduates, you can make sure that pain patients stay on track and receive additional treatment if their needs change.

Sources: Sg2 Interview With Rehabilitation Institute of Chicago, June 2016; American Pain Society. NIH study shows prevalence of chronic or severe pain in US adults [press release]. August 18, 2015; American Academy of Pain Medicine website. Accessed December 2016; Sg2 Ambulatory Market Strategist, 2016; Sg2 Impact of Change, 2016; Sg2 Analysis, 2016.

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