1. 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

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

3. 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?

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

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

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

7. 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

8. 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

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

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

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

14. Example of Pain Visit Flow Sheet

15. 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?