1. COLLABORATIVE APPROACH: CHRONIC PAIN MANAGEMENT FOR COMPLEX PATIENTS
Leslie Simons, DNP, ANP-BC
Cynthia Wolker-Pung, RN
Sparrow Pain Management Center

2. Leslie Simons: no conflicts of interest to disclose.
DISCLOSURES
Leslie Simons: no conflicts of interest to disclose.
Cynthia Wolker – Pung: no conflicts of interest to disclose.

3. CASE MANAGER ROLE AT PAIN CENTER
Referrals
Patient Demographics
Insurance Information
Current Medications
Progress Notes
Imaging

4. CASE MANAGEMENT TRIAGE
Triaging Point for Others
Physicians
APRNs
Social Workers
Registered Nurses
Encourage Referrals

5. RED FLAGS
Long Term Opioid Use
Medication
Comorbidity
Lab Work
Looking for Helpful Information
Specialty Comments

6. INTAKE ASSESSMENT PROCESS
Verify:
Demographics/Insurance
Pain Location/Duration
Pain Description
Underlying Conditions
Past Pain Treatment
Current Work Status
Psychological Assessment

7. CASE MANGEMENT PRESENTATIONS
DAILY CONFERENCE
BI-MONTHLY FULL CASE CONFERENCE

8. WHAT IS A SPINAL CORD STIMULATOR?
Surgical device implanted under skin.
Approximate size of pacemaker.
Delivers electrical impulses to spinal cord.
Helps patients better manage chronic pain symptoms.
Decreasing use of opioid medications.

9. Spinal Cord Stimulation
A spinal cord stimulator works by masking pain signals before they reach the brain. The device approximately the size of a small pacemaker, is surgically implanted under the skin and sends a mild electric current to the spinal cord. A small wire carries a current from a pulse generator to the nerve fibers of the spinal cord & when turned on stimulates the nerves in the area of pain. Pain is reduced because the electrical pulses modify/mask the pain signal from reaching your brain.

10. Nurse Practitioner Role
Patient Selection
Patient Assessment
Patient Teaching
Plan of Care
Collaboration with Nurse Case Manager

11. CASE ONE 58 year old male patient.
Bilateral back & right lower extremity pain.
History of 5 back surgeries
3 lumbar decompression laminectomies & 2 lumbar fusions.
Failed interventional management and physical therapy.
Patient also undergoing cardiac workup, problems with obtaining cardiology notes/PCP states check with cardiology/Cardiologist states check with PCP. Insurance MCR + Blue.
What red flags do you see?
What are the next steps in caring for this patient?

12. CASE TWO 82 year old male patient. Right lower extremity pain.
Primary caregiver for spouse with dementia.
Problems finding driver/caregiver for wife.
Poor Historian.
Medical History
Type One Diabetic: DPN/CHF/HTN/MI x 2
Coronary Artery Stent, Pacemaker /Defibrillator.
Currently prescribed Coumadin.
What red flags do you see?
What are the next steps for caring for this patient?
What problems can occur?
What did we do?
Cannot remember who primary care physician or cardiologist is, who implanted AICD, or who prescribes Coumadin.
Received permission from cardiology to discontinue Coumadin for at least 7 days.

13. QUESTIONS