UHC Pain Researchers Win Grant to Reach More Patients

CLEVELAND --  The Josiah Macy Jr. Foundation has awarded $983,000 to physicians specializing in pain management at University Hospitals of Cleveland and Case Western Reserve University for a project that will help primary care physicians strengthen their abilities to care for patients in chronic pain. This novel approach to medical education focuses primary care medicine on a health problem that disables 23 million people at a cost to society of $90 billion annually.  

Thomas C. Chelimsky, MD, neurologist and associate professor of neurology at Case Western Reserve University, said the grant promises to instill primary care physicians with the expertise to effectively treat greater numbers of patients for chronic pain-an arena in healthcare currently dominated by chronic pain specialists and interdisciplinary pain programs.

"Already we have developed an experiential learning program in chronic pain for primary care physicians and thus far we have registered very positive results," Dr. Chelimsky said. "This new research funding will expand our initiative to a broader level of interdisciplinary pain care by teaming 24 primary care physicians with a psychologist, pharmacist, study nurse, and several physical and occupational therapists who will be trained in the special rehabilitation needs of chronic pain patients."

Dr. Chelimsky is co-author of a study in the April issue of Pain Physician that documented the effectiveness of a month-long multi-disciplinary approach to pain management. Researchers reported that patients improved their physical functions, their anxiety levels stabilized while their pain tolerance improved, and 75 percent of the patients were able to find employment.

Researchers will track patients according to their pain levels, depression scale, work status and quality of life, among other measures. Researchers also will collect data from other sources to determine the appropriateness of medication use, the doctors' satisfaction with their pain management, the ability of patients to access pain services and the cost of these services to hospitals.

Chronic pain has not been a condition that many doctors have been eager to treat. An editorial in the
July 1, 2002, issue of American Family Physician reported, "Of patients diagnosed with chronic pain and treated by a family physician, 64 percent report persistent pain two years after treatment initiation. Not surprisingly, only 15 percent of primary care physicians 'enjoy' treating patients with chronic pain."

According to Dr. Chelimsky, primary care physicians have traditionally avoided this area of medicine due to lack of formal training in pain management, fear of the complexities surrounding opiate use, lack of sufficient clinical support from other specialists, and a perception that chronic pain patients require more time and effort than most other patients.

"If chronic pain can be managed effectively at the primary care level, the potential number of patients served would increase exponentially," Dr. Chelimsky said. "For example, 50 primary care physicians in the Cleveland area spending one or two half-days seeing chronic pain patients each week could managed 5,000 patients to 10,000 patients a year-up to 30 times the number of patients that can be treated currently at intensive chronic pain programs in this area."

National health care groups, including the Joint Commission on Accreditation of Health Care Organizations, have recognized the growing need of chronic pain sufferers to find easier access to screening and pain management. According to national statistics, interdisciplinary pain programs that foster collaboration between primary care physicians and a team of pain specialists, such as neurologists and psychologists, are far more effective than strategies relying on a single specialist for chronic pain therapy.

Posted on Monday, June 14, 2004 (Archive on Monday, June 21, 2004)
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