, Volume 2, Issue 1, pp 47-56

Managing pain in high-risk patients within a patient-centered medical home

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ABSTRACT

Chronic pain remains a major healthcare problem despite noteworthy advancements in diagnostics, pharmacotherapy, and invasive and non-invasive interventions. The prevalence of chronic pain in the United States is staggering and continues to grow, and the personal and societal costs are not inconsequential. The etiology of pain is complex, and individuals suffering from chronic pain tend to have significant medical and psychiatric comorbidities such as depression, anxiety, and in some cases, substance use disorders. There is great concern regarding the burgeoning rate of prescription opioid misuse/abuse both for non-medical use and in pain patients receiving chronic opioid therapy. While there is ongoing debate about the "true" incidence of opioid abuse in the pain population, clearly, patients afflicted with both pain and substance use disorder are particularity challenging. The majority of patients with chronic pain including those with co-occurring substance use disorders are managed in the primary care setting. Primary care practitioners have scant time, resources and training to effectively assess, treat and monitor these complicated cases. A number of evidence- and expert consensus-based treatment guidelines on opioid therapy and risk mitigation have been developed but they have been underutilized in both specialty and primary care clinics. This article will discuss the utilization of new technologies and delivery systems for risk stratification, intervention and monitoring of patients with pain receiving opioid.

Implications

Researchers: Explore the opportunity for translational and implementation research in the highly topical area of pain and opioid abuse in the primary care setting
Practitioners: Broaden knowledge on managing complex chronic pain patients employing the emerging patient-centered medical home model of care utilizing health information technology
Policymakers: Design reimbursement strategies and policies to incentivize healthcare institutions and practitioners to invest in health information technology to address the burgeoning public health crisis of opioid abuse and diversion