Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1020 — Implementation and Evaluation of the Integrated Pain Team: Pain Outcomes, Opioid Safety and Treatment Satisfaction among Veterans in Primary Care

Lead/Presenter: Joseph Grasso
All Authors: Grasso J (SFVAMC) Tighe J (SFVAMC) Li Y (SFVAMC) Seal KH (SFVAMC, UCSF)

Objectives:
The Integrated Pain Team (IPT) clinic, embedded in primary care, integrates and co-locates pain-trained primary care providers (PCPs), psychologists and pharmacists to provide interdisciplinary, biopsychosocial pain care for patients with complex chronic pain and aberrant opioid use. Other PCPs refer and IPT providers assume short-term management of pain care, conducting a warm hand-off back to the referring PCP for long-term pain management. In this ongoing Quality Improvement study, we assessed whether implementation of the new Integrated Pain Team (IPT) improves self-reported chronic pain-related outcomes, opioid safety and pain treatment satisfaction.

Methods:
To date, a prospective convenience sample of 56 veterans with chronic pain and high-risk opioid use have been enrolled and followed by the IPT clinic for at least 3 visits. Prior to their initial IPT clinic visit, all new patients were administered a baseline self-report questionnaire using a web-based data collection system. After three clinic visits with IPT, patients completed a follow-up assessment including the Current Opioid Misuse Measure (COMM), the Brief Pain Inventory (BPI), the Pain Catastrophizing Scale, and the Pain Treatment Satisfaction Scale.

Results:
After 3 IPT visits, the COMM score was significantly lower (mean: 6.13; Std: 0.80) compared to baseline (mean: 9.52; Std: 1.11), p = 0.002, representing a medium effect size (Cohen's D: 0.48). Likewise, the following domain scores were significantly lower at follow-up compared with baseline: average pain interference score (5.88 vs. 6.62, p = 0.016), Pain Catastrophizing Scale (PCS) magnification score (1.35 vs. 1.58, p = 0.034) and PCS helplessness score (1.60 vs. 1.88, p = 0.036). To date, there have been no significant improvements in pain treatment satisfaction.

Implications:
Within this relatively small sample of veterans with chronic pain and opioid misuse, after 3 IPT clinic visits, within-group differences indicate improvements in self-reported opioid misuse, pain interference and pain catastrophizing, despite a lack of measurable improvement in pain treatment satisfaction.

Impacts:
An interdisciplinary biopsychosocial pain care team embedded in primary care appears promising in decreasing opioid risk and improving pain interference and catastrophizing. Further research is needed to validate the finding of a lack of improved pain treatment satisfaction and to determine strategies to improve patients' chronic pain care experience in interdisciplinary pain clinics.