Pain training for primary care providers

Patients who experience chronic pain may experience improvement in symptoms if their primary care providers are specifically trained in multiple aspects of pain, including emotional consequences.

A collaborative team headed by Thomas C. Chelimsky, M.D., professor and chairman of the department of neurology at the Medical College of Wisconsin, conducted a pilot study assessing the Primary Practice Physician Program for Chronic Pain (4PCP) and its impact on both patients and providers.

The findings are published in the Clinical Journal of Pain, http://journals.lww.com/clinicalpain/toc/publishahead.

Chronic pain constitutes a heavy burden on healthcare systems, with more than 17 million disabled Americans reporting pain as the primary disability. Primary care providers report pain as the chief symptom of one third of their patients, yet many have little or no training in chronic pain management.

The 4PCP program is designed to train physicians to lead an interdisciplinary team in managing patients with chronic pain; the team includes a pain-informed psychologist, occupational therapist, and a physical therapist, along with the physician.

In the study, physicians were randomized either to receive the training program immediately, or after a one-year control period. Both patients and physicians were evaluated after the intervention to measure its effectiveness.

Patients with chronic pain experienced significant benefits, including reduced pain, fatigue, and depression. Physicians reported more comfort in assessing and treating those patients, and shorter visit times.

"We hope to avert chronic pain syndrome, and instead see improved return-to-work rates, fewer emergency room visits, and significantly improved emotional well-being in these patients," said Dr. Chelimsky. "From a physician perspective, we observed greater job satisfaction and more efficiency. Economically, the impact of 4PCP training could be significant as well in health care dollars saved."

Dr. Chelimsky's collaborators on the study include Robert L. Fischer, Ph.D., Mandel School of Applied Social Sciences, Case Western Reserve University; Jennifer B. Levin, Ph.D., and Jeffrey W. Janata, Ph.D., Department of Psychiatry, Case Medical Center, Case Western Reserve University School of Medicine and University Hospitals; Mark I. Cheren, Ed.D., Healthcare Improvement Skills Center, Improvement Learning, Shaker Heights, Ohio; and Sybil K. Marsh, M.D., Department of Family Medicine, Case Medical Center, Case Western Reserve University School of Medicine and University Hospitals.

The Medical College of Wisconsin is the state's only private medical school and health sciences graduate school. Founded in 1893, it is dedicated to leadership and excellence in education, patient care, research and service. More than 1,200 students are enrolled in the Medical College's medical school and graduate school programs. A major national research center, it is the largest research institution in the Milwaukee metro area and second largest in Wisconsin. In FY 2011 – 12, faculty received more than $166 million in external support for research, teaching, training and related purposes, of which more than $152 million is for research. This total includes highly competitive research and training awards from the National Institutes of Health (NIH). Annually, College faculty direct or collaborate on more than 2,000 research studies, including clinical trials. Additionally, more than 1,350 physicians provide care in virtually every specialty of medicine for more than 425,000 patients annually.