Managing Chronic Pain in Primary Care: It Really Does Take a Village.
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.
San Francisco VA Healthcare System, Box 116-A, 4150 Clement Street, San Francisco, CA, 94121, USA. karen.seal@ucsf.edu.|University of California, San Francisco, San Francisco, CA, USA. karen.seal@ucsf.edu.
Karen
K
Seal
VA Connecticut Healthcare System, West Haven, CT, USA.|Yale University School of Medicine, New Haven, CT, USA.
William
W
Becker
San Francisco VA Healthcare System, Box 116-A, 4150 Clement Street, San Francisco, CA, 94121, USA.
Jennifer
J
Tighe
San Francisco VA Healthcare System, Box 116-A, 4150 Clement Street, San Francisco, CA, 94121, USA.
Yongmei
Y
Li
San Francisco VA Healthcare System, Box 116-A, 4150 Clement Street, San Francisco, CA, 94121, USA.
Tessa
T
Rife
D059350:Chronic Pain / Q000628:therapy*; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D006801:Humans; D059408:Pain Management / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*
chronic pain; interdisciplinary care; opioids; primary care