Treatment of Clients Experiencing Pain Disorders A Collaborative Approach to Care June 2, 2018 * Tex-CHIP Training Series

Medical Management of Symptoms

Understanding Provider Role in Treating Pain Disorders The provider needs to perform a thorough assessment to determine appropriate interventions. (There are practice guidelines available.) Not only is there a determination about duration, location, quality and intensity of pain, but what helps and what exacerbates the pain experience. This includes medications, prescribed and over-the-counter (how they are being taken) and other non-pharmacologic measures. ALWAYS MINDFUL: Inadequate management of pain can lead to adverse patient outcomes. These can be physical and/or psychological. Unrelieved pain prolongs the stress response. This can impact the endocrine, metabolic, cardiovascular gastrointestinal, renal, and/or immune systems. Common psychological responses include anxiety and/or depression. Bottom line: treating pain disorders is complicated and often requires an interdisciplinary team for best results.

Considerations when Interacting with Clients It can be a challenge to set goals for pain control when the pain is chronic. The individual would want “zero” pain. Goal setting must be collaborative and realistic. Example: “Sometimes it is not possible to completely eliminate all pain, but our goal can be to reduce your pain to a reasonable level, step-by-step. Part of this will include attention to unpleasant side effects of pain medication.

Our Treatment Plan Healthcare Domain: Primary Care - Provider: Nurse Practitioner Objective: Provide relief of symptoms as indicated by client report of: Minimal side effects from analgesic regimen (b) Maintenance or improved functional ability (c) Experience of pain relief or reduced pain (do not expect “no pain”)   Goals: MUST be developed with each individual client and may include: A decrease in pain intensity rating (a 33-50% decrease in pain intensity is typically a reasonable standard for determining efficacy of an intervention.) b) A decrease in percent of pain (reflected as a 1 – 2 point change on a 0 – 10 point scale.) c)  Functional Goal (physical or emotional) Uwhealth.org/pain: Establishing Pain Relief Goals Interventions: MUST be developed individually with each client – for Michelle from the case study:  Consider the addition of an antidepressant AND set realistic expectations/teaching about this medication. May delay until client sees a MH provider. b)  Work with Michelle (from the case study) to accept a referral to a mental health provider, understanding she has seen many providers over the past 13 months. c) Consider reinforcing the use of exercises used during physical therapy and encourage “complimentary” interventions based on client’s preferences

Measuring Outcomes/ Success Client report of: Minimal side effects from analgesic regimen (b) Maintenance or improved functional ability. This needs to be carefully gauged, one step at a time so the client can see gains and feel the care “team” believes her and wants to work with her. (c) Experience of pain relief or reduced pain - do not expect “no pain. “ (See goals – previous slide)     

Communication from Counselors What are the assessment findings? What are the treatment approaches being considered? How can the PCP best support the work of the MH provider? What is the best way to manage follow-up appointments (knowing initially the commute is tiring to the client)