Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Mar;2(1):47-56.
doi: 10.1007/s13142-012-0113-z.

Managing pain in high-risk patients within a patient-centered medical home

Martin D Cheatle  1 , John W Klocek, A Thomas McLellan
Affiliations

Managing pain in high-risk patients within a patient-centered medical home

Martin D Cheatle et al. Transl Behav Med. 2012 Mar.

Abstract

Chronic pain remains a major healthcare problem despite noteworthy advancements in diagnostics, pharmacotherapy, and invasive and non-invasive interventions. The prevalence of chronic pain in the United States is staggering and continues to grow, and the personal and societal costs are not inconsequential. The etiology of pain is complex, and individuals suffering from chronic pain tend to have significant medical and psychiatric comorbidities such as depression, anxiety, and in some cases, substance use disorders. There is great concern regarding the burgeoning rate of prescription opioid misuse/abuse both for non-medical use and in pain patients receiving chronic opioid therapy. While there is ongoing debate about the "true" incidence of opioid abuse in the pain population, clearly, patients afflicted with both pain and substance use disorder are particularity challenging. The majority of patients with chronic pain including those with co-occurring substance use disorders are managed in the primary care setting. Primary care practitioners have scant time, resources and training to effectively assess, treat and monitor these complicated cases. A number of evidence- and expert consensus-based treatment guidelines on opioid therapy and risk mitigation have been developed but they have been underutilized in both specialty and primary care clinics. This article will discuss the utilization of new technologies and delivery systems for risk stratification, intervention and monitoring of patients with pain receiving opioid.

Keywords: Addiction; Electronic health record systems; Health care reform; Opioids; Pain; Patient-centered medical home.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Chronic disease model for managing pain in risky patients. ORT Opioid Risk Tool, SBIRT Screening, Brief Intervention and Referral to Treatment, SOAPP Screener and Opioid Assessment for Patients with Pain, CA-CBT Computer-assisted cognitive behavioral therapy, BDI Beck Depression Inventory, COMM Current Opioid Misuse Measure, UDS Urine Drug Screen, POMS Profile of Mood States
Fig 2
Fig 2
Opioid monitoring algorithm
See this image and copyright information in PMC

References

    1. Tsang AM, Von Korff S, Lee J, Alonso E, Karam MC, Angermeyer GL, et al. Common chronic pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9(10):883–891. doi: 10.1016/j.jpain.2008.05.005. - DOI - PubMed
    1. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press; 2011. - PubMed
    1. Breuer B, Cruciani R, Portenoy RK. Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: A national survey. South Med J. 2010;103(8):738–747. doi: 10.1097/SMJ.0b013e3181e74ede. - DOI - PubMed
    1. Upshur CC, Luckmann RS, Savageau JA. Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006;21(6):652–655. doi: 10.1111/j.1525-1497.2006.00412.x. - DOI - PMC - PubMed
    1. Patient Protection and Affordable Care Act. Public Law No: 111-148: H.R. 3590. March 23, 2010.