Faculty Practice:Development of a Pain Management practice

An inner city community hospital approached me to develop a Pain Management practice in a Ryan White funded HIV clinic.  A majority of the clinic patients became HIV + from intravenous substance abuse. Many of these patients received opiates during early treatment of this disease and have now survived 15 to 20 years and continue drug seeking behavior for personal use or for the purpose of diversion.  With the increase of federal and state regulatory oversight of Controlled Dangerous Substances, many providers no longer want to provide medical management for the treatment of pain. Additionally, formal substance abusers are a  very difficult population to deal with due to manipulative and coercive behaviors.

Goals of this faculty practice were to improve patient outcomes with regard to pain management, decrease drug abuse and diversion, establish treatment guidelines for all patients seen in the pain practice, and provide education of APN students, pharmacy students, fellows, residents, and nurses.

Successes of this faculty practice include the development of policy and clinic guidelines for pain treatment, identification of essential documentation needed for each visit to comply with federal and state requirements, decrease in opioid quantities prescribed to patients,  and a decrease in diversion. 

Barriers to maintaining guidelines for pain treatment include a rotating clinic staff  and fragmented care by specialists, a large patient caseload and limited time for patient visits. 

Students in the Adult/Gero and family primary care tracks will rotate through this clinic during one of their clinical rotations in the program.  During this past year we have concentrated on rotating students who are at the end of their program.