San Francisco VA Health Care System
Integrated Pain Team
In a new perspective piece titled “Managing Chronic Pain in Primary Care: It Really Does Take a Village,” recently published in The Journal of General Internal Medicine, a team of SFVAMC researchers note the hurdles health care providers face in managing chronic pain in their patients. Often, primary care providers offload chronic pain management to pain specialists. However, a 2015 report from the Centers for Disease Control and Prevention recommends an interdisciplinary team approach to pain management, including a mixture of exercise therapy, cognitive-behavioral therapy, and non-opioid medication prescriptions.
This approach has been embraced by SFVAMC, which established its Integrated Pain Team (IPT) in July 2015. The IPT is embedded in the primary care setting, where pain-trained primary care providers work closely with a psychologist and a pharmacist and have expedited access to physical and occupational therapy. This integrated approach allows IPT providers to treat the patients’ chronic pain while also addressing comorbidities common to the Veteran population - such as posttraumatic stress disorder and depression – that might be predictors of opioid abuse.
The IPT has already produced quantifiable patient care outcomes. A recent quality management study examined 162 Veterans with chronic pain who receive care at SFVAMC – 81 who are enrolled in the IPT and 81 who are in other SFVAMC primary care clinics. After 90 days of treatment, the Veterans in the IPT group reported a greater reduction in their daily opioid use than those in the non-IPT clinics (41.2 mg vs. 24.8 mg reductions). Veterans in the IPT group were more than twice as likely to have reduced their opioid use by 50% or more compared to the non-IPT Veterans.
The results were even more pronounced after 180 days. The daily prescription dose of opioids for Veterans in the IPT group was 103% lower than that of the non-IPT group. IPT-enrolled Veterans were 3.6 times more likely to have reduced their opioid prescription use by 50% or more after 180 days compared to the non-IPT Veterans.
“The Integrated Pain Team approach is something the VA is uniquely equipped to provide,” says Karen Seal, MD, MPH, Director of the SFVAMC Integrated Pain Team and primary author of the study. “Chronic pain management is very fragmented in the private sector. We already provide an integrated, interdisciplinary approach to patient care, and our pain management program builds on our strengths.”
“We really are ahead of the curve on chronic pain management,” says Dr. Seal. She views the IPT as a best practice that should be strengthened and maintained within the VA system and broadly disseminated to other health care systems.
“Outsourcing the work of the IPT to the private sector right now would be impossible,” says Dr. Seal. “It is important to preserve and continue the VA model of healthcare so we can continue to develop fully integrated and patient-centered approaches to patient care.”
This perspective piece was published electronically in The Journal of General Internal Medicine. You can read the article at: http://link.springer.com/article/10.1007/s11606-017-4047-5.
Co-authors of the study are: William Becker, MD (VA Connecticut Health Care System); Jennifer Tighe, MSPH (SFVAMC); Yongmei Li, PhD (SFVAMC); and Tessa Rife, PharmD, CACP, CGP (SFVAMC).
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at University of California, San Francisco.
To learn more about Pain Management in the San Francisco VA Health Care System, talk to your primary care provider.