Managing Chronic Pain in Primary Care: It Really Does Take a Village
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Some healthcare systems are relieving primary care providers (PCPs) of “the burden” of managing chronic pain and opioid prescribing, instead offloading chronic pain management to pain specialists. Last year the Centers for Disease Control and Prevention recommended a biopsychosocial approach to pain management that discourages opioid use and promotes exercise therapy, cognitive behavioral therapy and non-opioid medications as first-line patient-centered, multi-modal treatments best delivered by an interdisciplinary team. In the private sector, interdisciplinary pain management services are challenging to assemble, separate from primary care and not typically reimbursed. In contrast, in a fully integrated health care system like the Veterans Health Administration (VHA), interdisciplinary clinics already exist, and one such clinic, the Integrated Pain Team (IPT) clinic, integrates and co-locates pain-trained PCPs, a psychologist and a pharmacist in primary care. The IPT clinic has demonstrated significant success in opioid risk reduction. Unfortunately, proposed legislation threatens to dismantle aspects of the VA such that these interdisciplinary services may be eliminated. This Perspective explains why it is critical not only to maintain interdisciplinary pain services in VHA, but also to consider disseminating this model to other health care systems in order to implement patient-centered, guideline-concordant care more broadly.
KEY WORDSchronic pain opioids interdisciplinary care primary care
The results reported in this commentary would not be possible without the hard work of the Integrated Pain Team Clinic staff at the San Francisco VA Healthcare System, whose members include: Sarah Palyo, PhD; Erin Watson, PhD; Payal Marpara, PhD; Caitlin Garvey, NP; Christina Tat, PharmD, BCPS; and Elizabeth Son, PharmD. We wish to thank Thomas Metzler, MS, for assisting with statistics, and Ana-Marie Urbieta for her former military service and work on this study. We also acknowledge Russell Lemle, PhD, and Suzanne Gordon for their contributions to this perspective.
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Compliance with Ethical Standards
Preliminary research reported in this commentary is funded by a Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI) award (Mary Whooley, MD, Principal Investigator). The views expressed are those of the authors only and do not reflect the opinions of the Veterans Health Administration.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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