1. SCOPE: Empowering Family Physicians to Manage Chronic Pain
F. Stuart Leeds1 and Josephine F. Wilson 2
Departments of Family Medicine1 and Community Health 2, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
Introduction
Results
Chronic nonmalignant pain (CNMP) is one of the most common reasons for office visits to family physicians.
Because there is no defined scope of practice for CNMP, family physicians are reluctant to treat these patients – and often lack the training to do so
SCOPE is an evaluation and treatment protocol based on a defined scope of practice, and driven by evidence-based management principles
We hypothesized that SCOPE can be taught to FM residents in one or two brief, intensive clinical sessions; and that…
Once learned, SCOPE will measurably enhance a resident’s experience managing patients with chronic pain
The Concentric Circles of Scope-of-Practice
(MALPRACTICE)
SCOPE is aimed at expanding this inner circle
Outer limits defined by the specialty itself
Regional/local
“cultural”
standards
Individual
Training, Skill
& Prerogatives
SCOPE – Scope-of-Care Oriented Pain Engagement
The DESCRIBE Acronym
Simplifying the Initial Evaluation of Patients with Chronic Pain
SCOPE’s core is its scope-of-practice definition. Patients must:
Be reliable and reasonable
Be straightforward (medically and functionally)
Have exhausted non-opioid alternatives
SCOPE’s principles of treatment include:
Preferential use of long-acting opioids
Best use of opioid-sparing adjuncts
“Universal precautions” – compliance testing for all
Duration - must be chronic (>12 weeks)
Etiology - one or more clear diagnoses to explain pain symptoms
Story - narrative from onset to present
Consultation – has been evaluated by appropriate specialist
Red Flags? – by history, exam, labs, or PDMP
Irreversible? - reversible causes of chronic pain addressed
Basic– patient’s overall clinical picture and proposed regimen are not excessively complex
Exhausted all reasonable non-opioid alternatives
Summary of Results
Brief SCOPE training resulted in statistically-significant changes in pre/post questionnaire scores.
Sixteen of eighteen questions trended in the direction of improvement
Seven questions achieved individual statistical significance, including the key item:
“I feel comfortable managing patients with chronic non-malignant pain.”
Subjective Experience and Perceived Competence improved significantly
Total (overall “readiness”) scores also improved significantly
Methods
Conclusion
SCOPE is a chronic pain management protocol built on an explicit definition of scope of practice for family physicians
SCOPE can be rapidly and effectively taught to family medicine residents in an office setting
Use of SCOPE results in a better physician experience with respect to chronic pain patients
SCOPE, therefore, has the potential to enhance access to care for patients with CNMP
Twelve family medicine residents, all levels of training, studied over three years
Residents were trained to use SCOPE in two intensive clinical half-days with chronic pain patients
Eighteen-item Likert scale questionnaires regarding resident attitudes, beliefs and experiences regarding CNMP patients were completed before and after SCOPE training
Individual and total scores, as well as scores for the 4 question categories (Subjective Experience, Perceived Competence, Provider Beliefs, and Provider Behavior) were analyzed using paired T-tests.
Reference:
Leeds FS, Wilson JF (2014) A Novel Scope-of-Practice Based Paradigm for Empowering Family Physicians to Manage Chronic Nonmalignant Pain. J Family Med Community Health 1(4): 1023.
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