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Functional rehabilitation and pain management

Kevin A. Kapov, DO, Chief Clinical Innovation Officer, Director, Center for Clinical Innovation, Southwest Medical Associates

Toni Corbin, Executive Vice President of Operations, Southwest Medical Center for Clinical Innovation, Department of Functional Rehabilitation and Pain, Southwest Medical Associates

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The multi-model model for musculoskeletal dysfunction and pain

Almost 1/3 of all Americans experience severe chronic pain at some point in their lives1, making it the most common cause of long term disability.2 Over the last decade the emergence of the opioid crisis has elevated chronic pain to a public health emergency. 

Researchers, physicians, government agencies and health care delivery organizations are all pouring effort into solving the treatment dilemma of chronic pain.

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Defining chronic pain

Chronic pain is defined as pain that has persisted beyond the expected recovery time for a given injury, pain that exists in the absence of any injury, or that continues for more than three months. 

Once thought of as strictly a physical symptom; we now understand the psychosocial component of chronic pain and importance of addressing this aspect of treatment.

It has become clear that long-term use of opioid pain medication, although effective in some cases at appropriate doses, is not always the answer in the treatment for chronic non-cancer pain. Many times patients are not given proper expectations for the control of pain.

In fact, unrealistic expectations with escalating doses of opioids can lead to adverse effects, which run from constipation to dependence, addiction and increased mortality.

Clinicians are becoming more educated to the negative outcomes linked to long-term use of opioids for chronic pain. At Southwest Medical, we have reduced prescription numbers and pill counts, and work to educate our patients on more effective pain management without opioids.

However, chronic pain is a real and debilitating phenomenon. We, as clinicians, are bound to care for our suffering patients, who need a safe and effective treatment plan.

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The nature of pain

Southwest Medical has pursued the difficult and tedious task of reviewing the best evidence, providers and approaches for chronic pain and physical dysfunction intervention, and created the Center for Clinical Innovation.

Our Center addresses pain in the context of care, planning treatment for the whole person. Pain is rarely an isolated phenomenon.

In our clinical initiative, we have defined steps for addressing both chronic pain and associated dysfunction. 

The primary reason for chronic pain in our patients is often not occupational associated injury, but rather other chronic and acute conditions such as osteoarthritis, lingering pain from a previous surgery and injuries that have gone untreated.

The history of chronic pain is unique to each patient, and the plan for each patient is individualized.

Setting appropriate goals

To provide our patients with the best possible treatments, our approach is multi-modal. 

First, a complete evaluation is conducted, taking  into account the entirety of their medical history. This allows our patients to communicate with their clinician in a way that develops trust and understanding through a compassionate approach.

Next, we work to set appropriate goals. Rather than just prescribing a pain medication, assuming the goal of the intervention is achievement of zero pain, patient and clinician will develop a specific treatment plan with the goal of an improved level of function. 

Moving from dependence on pain scores (focusing on pain) to improving the life experience and functional level of individuals with chronic pain, is consistent with the approaches recommended by the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain3 and the Department of Health and Human Services’ National Pain Strategy.4

Modalities for individualized care

Multimodal approaches with interdisciplinary management of patients with chronic pain have shown success in rehabilitation of various patient populations.5,6 

Aspirations for the Southwest Medical’s Functional Rehabilitation and Pain department include: co-location of specialists, mental health professionals, physical therapists and manual manipulation practitioners to help tackle the various aspects of pain and functional limitation management in a streamlined manner. 

Embedding behavioral health is a core component of our program as we strive to address the psychological component of chronic pain and dysfunction.

Cognitive behavioral therapy, for instance, has been shown to help patients cope with pain and is recommended as one of the first-line treatments for chronic pain.5,7

We have begun first-line evaluations of innovations such as virtual reality (VR). VR has shown great promise in this area and has already been used in the treatment of psychological issues and providing aid in physical therapy in a virtual environment. 

The goal is to train the patient on the use of VR devices using specific programs that can help them cope with their pain and generalize the strategies learned within the VR platform to their lives. 

Adding the VR platform will help reach more patients, provide a clinic-independent sustained and convenient pain management tool that empowers the patient, improving their coping skills and reducing medication dependence.

Future growth

Southwest Medical’s initial effort, once realized, will be deployed at other locations with a smaller footprint. The VR intervention might start with a simple program for stress resiliency training. 

We will evaluate the outcomes and seek input from stakeholders, including patients, refining before scaling the program up.

We have a skeleton core team in place, and as we gather data and feedback we intend to scale this program to meet the needs of our chronic pain patients. 

Southwest Medical’s senior leadership team and our UHG and Optum partners remain committed to meet the dilemma of pain, chronic dysfunction and the opioid crisis with our best people, and offer our patients the best possible care. 

Our goal is to improve lives by offering our patients the tools to overcome chronic pain. With our best efforts, we will improve function, and the way in which chronic pain is addressed. We are just beginning this journey.

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  1. Tompkins DA, Hobelmann JG, Compton P. Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug Alcohol Depend. 2017;173(Suppl 1):S11-S21. doi:10.1016/j.drugalcdep.2016.12.002 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771233/pdf/nihms917135.pdf.
  2. American Pain Society. Pain Monograph. http://americanpainsociety.org/uploads/education/npc.pdf. Accessed June 28, 2019.
  3. CDC Guideline for Prescribing Opioids for Chronic Pain | Drug Overdose | CDC Injury Center. https://www.cdc.gov/drugoverdose/prescribing/guideline.html. Published April 17, 2019. Accessed June 28, 2019.
  4. National Pain Strategy. Interagency Pain Research Coordinating Committee. https://www.iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf. Accessed June 28, 2019.
  5. Seal K, Becker W, Tighe J, Li Y, Rife T. Managing Chronic Pain in Primary Care: It Really Does Take a Village. J Gen Intern Med. 2017;32(8):931-934. doi:10.1007/s11606-017-4047-5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515788/pdf/11606_2017_Article_4047.pdf.
  6. Interdisciplinary Chronic Pain Rehabilitation Program Shown as Successful Method for Treating Older Adults with Chronic Pain. AAPM. https://painmed.org/aapm-news/interdisciplinary-chronic-pain-rehabilitation-program-shown-as-successful-method-for-treating-older-adults-with-chronic-pain. Accessed June 28, 2019.
  7. Mental Health Services in Pain Clinics Provide Significant Clinical Benefits to Patients with Chronic Pain. AAPM. https://painmed.org/aapm-news/mental-health-services-in-pain-clinics-provide-significant-clinical-benefits-to-patientswith-chronic-pain. Accessed June 28, 2019.

This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice. 

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