Redesigning Delivery of Opioids to Optimize Pain Management, Improve Outcomes, and Contain Costs

Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
Pain Medicine (Impact Factor: 2.3). 12/2012; 14(1). DOI: 10.1111/pme.12013
Source: PubMed


Chronic pain is a public health concern, and in the last decade, there has been a dramatic increase in the use and abuse of prescription opioids for chronic non-cancer pain.

We present an overview of a five-component model of pain management implemented at the University of Washington Division of Pain Medicine designed to facilitate recent state guidelines to reduce the risks associated with long-term use of prescription opioids.

Central to the model described are guidelines for best clinical practice, a collaborative care approach, telehealth solutions, comprehensive prescription-monitoring, and measurement-based care.

The model presented is a patient-centered, efficient, and cost-effective approach to the management of chronic pain.

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    • "This team consists of a nurse case manager and a pain physician working in collaboration with the PCP. Cahana et al106 outlined a patient-centric and cost-effective collaborative pain care model to maximize the benefit of opioids while reducing the risk of misuse/abuse. Based at the Division of Pain Medicine, University of Washington, a regional telemedicine program known as “Telepain” was developed for chronic pain management and encompassed a number of rural and underserved states. "
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    ABSTRACT: Chronic pain is complex, and the patient suffering from chronic pain frequently experiences concomitant medical and psychiatric disorders, including mood and anxiety disorders, and in some cases substance use disorders. Ideally these patients would be referred to an interdisciplinary pain program staffed by pain medicine, behavioral health, and addiction specialists. In practice, the majority of patients with chronic pain are managed in the primary care setting. The primary care clinician typically has limited time, training, or access to resources to effectively and efficiently evaluate, treat, and monitor these patients, particularly when there is the added potential liability of prescribing opioids. This paper reviews the role of opioids in managing chronic noncancer pain, including efficacy and risk for misuse, abuse, and addiction, and discusses several models employing novel technologies and health delivery systems for risk assessment, intervention, and monitoring of patients receiving opioids in a primary care setting.
    Journal of Pain Research 06/2014; 7:301-11. DOI:10.2147/JPR.S37306
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    ABSTRACT: SUMMARY Chronic pain affects a wide range of outcomes that are typically assessed using self-reported methodologies, which are susceptible to recall biases, current mood and pain intensity. Physical activity (PA) is an important component of the pain experience that can be objectively assessed with accelerometers, which are small, lightweight devices that measure the duration, frequency and intensity of PA over time. Accelerometry provides opportunities to compare actual and perceived PA, to design individually customized treatments, to monitor treatment progress, and to evaluate treatment efficacy. Thus, this technology can provide a more refined understanding of the relationships among symptoms, perceptions, mood, environmental circumstances and PA. The current paper examines patterns of PA in chronic musculoskeletal pain conditions and identifies potential clinical applications for accelerometry.
    11/2013; 3(6):467-74. DOI:10.2217/pmt.13.46
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    ABSTRACT: There has been a widespread call for an ethics in the management of patients with chronic pain which is patient centered and takes into account the lived experience of the patient. It has been argued in literature that current "duty" or principlist-based models of ethics (so-called 3rd person ethics) have not adequately addressed the needs of either patients or practitioners in this area. Two strands of literature within phenomenology were reviewed: the literature of interpretative phenomenological analysis and the study of the lived experience of the person with chronic pain; and the contribution of phenomenology in neo-Aristotelian virtue ethics (1st person ethics). Patients experience chronic pain in existential and moral terms in addition to their biomedical issues, facing dilemmas in understanding their own self-identity and in attempting to recover a sense of moral worth and agency. We outline a patient-centered ethics to underpin contemporary collaborative, multimodal approaches in the management of chronic pain. We firstly describe an agency-oriented, neo-Aristotelian 1st person ethics and then outline a hermeneutic relationship with extant "duty-based," 3rd person bioethics. The utility of the ethics model we propose (the ethical reasoning bridge) lies in its capacity for developing a sense of moral agency for both practitioner and patient, resonating with the current emphasis of seeking active engagement of patients in management.
    Pain Medicine 12/2013; 15(3). DOI:10.1111/pme.12306 · 2.30 Impact Factor
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