Managing the Patient with Chronic, Non-Malignant Pain in a Family Medicine Residency Setting David McBride MD Boston University Department of Family Medicine James Bath MD Tufts University Family Medicine Residency

Problem scope What percentage of a typical patient population has “chronic pain”? 19%

Problem scope How many in the audience care for patients with chronic pain? How many have never had a “problem” with a patient with chronic pain? How many of your staff has been yelled at on the phone or in person by a patient with chronic pain?

Problem scope How many patients feel frustrated about their chronic pain treatment?

Please record your thoughts! Brainstorm Typical provider problems that occur in chronic pain management. Typical staff problems… Typical patient frustrations… Please record your thoughts!

Program Purpose Standardize patient care Improve prescribing practices Reduce anxiety Establish uniform guidelines Protect staff

Goals Short Term Create a practical contract Establish referral program Develop med screening protocol Establish code of conduct policy Prescribe in the best interest of our patients & Ensure proper use of potentially harmful medications

Goals Long term Pain Center model Establish triage system to screen & monitor new and existing patients Psychiatric co-management Expanded referral network for alternate treatment modalities Culture of appropriate prescribing and use

Elements Revised Patient Contract Requisite Referrals Program New Rx Pads Medication Screening Protocol Code of Conduct Policy Chart Review

Results Standardize patient care Improve prescribing practices Reduce anxiety Establish uniform guidelines Protect staff

Objective measures for pain Visual analog scale Brief pain inventory SOAPP aberrant behavior scale Beck depression inventory Beck anxiety inventory

Example of Pain Visit Flow Sheet

Problems and potential solutions What problems with management came up in your discussions? What potential solutions to these problems can be built with an organized approach?