An Interprofessional Approach to Chronic Pain Management and Education

Background and Objectives: The opioid epidemic highlights the importance of evidence-based practices in the management of chronic pain and the need for improved resident education focused on chronic pain treatment and controlled substance use. We present the development, implementation, and outcomes of a novel, long-standing interprofessional safe prescribing committee (SPC) and resulting policy, protocol, and longitudinal curriculum to address patient care and educational gaps in chronic pain management for residents in training. Methods: The SPC developed and implemented an opioid prescribing policy, protocol, and longitudinal curriculum in a single, community-based residency program. We conducted a postcurriculum survey for resident graduates to assess impact of knowledge gained. We conducted a retrospective chart review for patients on chronic opioid therapy to assess change in morphine equivalent dosing (MED) and pain scores pre- and postintervention. Results: A postcurriculum survey was completed by 20/26 (77%) graduates; 18/20 (90%) felt well-equipped to manage chronic pain based on their residency training experience. We completed a retrospective chart review on 57 patients. We found a significant decrease in MED (-20.34 [SE 5.12], P<.0001) at intervention visit with MED reductions maintained through the postintervention period (-9.43 per year additional decrease [SE 5.25], P=.073). We observed improvement in postintervention pain scores (P=.017). Conclusions: Our study illustrates the effectiveness of an interprofessional committee in lowering prescribed opioid doses and enhancing chronic pain education in a community-based residency setting.

Acceptance and Commitment Therapy and Exercise: Can They Help Older Adults Manage Chronic Pain?

Chronic pain is common among older adults and affects their physical and psychological well-being. While exercise can reduce pain and promote physical functions, psychological interventions may enhance pain management by addressing the psychosocial contributors to the prolonged pain. Acceptance and Commitment Therapy (ACT) is a psychological intervention that emphasizes on psychological flexibility, values, and mindfulness. This approach may be particularly helpful in dealing with chronic pain, where symptoms can be beyond one’s control. This single group pre-post study investigated the feasibility and efficacy of an intervention combining ACT and exercise for chronic pain management in older adults. The intervention consisted of 16 sessions delivered over eight weeks. ACT and exercises were modified according to the individual’s capability when needed. Clinical outcomes regarding pain severity and interference, pain acceptance, value of life, depression, anxiety, and physical functioning were assessed. Twenty-four older adults attended all sessions and completed the assessments. Preliminary results showed that, while participants experienced similar level of pain after the intervention, they reported less pain interference on mood and enjoyment of life, and improved chronic pain acceptance, pain self-efficacy, success at living their values, committed action, depressive symptoms, physical functioning in the lower body strength, aerobic and endurance, agility and dynamic balance, and upper body strength (all p<.050). This study lends support to the feasibility of a combined ACT and exercise intervention for chronic pain management in older adults. The efficacy of ACT may not be directly on reducing pain, but on increased psychological flexibility to co-live with pain.

Patient perspectives from the multi-disciplinary chronic pain clinic: a qualitative study

Aim: The chronic pain clinic (CPC) is a multi-disciplinary program that incorporates pharmacological and non-pharmacological methods, including First Nations healing strategies, to manage pain, improve functioning and reduce opioid misuse among patients with chronic pain in Regina, Canada. Materials & methods: The care experiences of ten current clients were explored using a narrative interview approach. Results: The CPC provides high-quality and safe care for effective chronic pain management. Clients noted pain reduction and improvements in sleep, mobility, functionality, and mood. First Nation clients emphasized the importance of traditional healing strategies. Conclusion: This unique comprehensive multi-modal approach which incorporates First Nations healing strategies is effective in supporting the unique needs of local clients.

P.153 Profiles and Outcomes of Workers’ Compensation Patients Undergoing Spinal Cord Stimulation for Persistent Post Surgical Pain

Background: The challenges of chronic pain management, and resulting poorer outcomes, in workers’ compensation (WCB) patients has been well established. Spinal cord stimulation (SCS) has been used for the management of low back and radicular neuropathic pain with varying effectiveness and it’s efficacy in the WCB population has been challenged. We sought to examine our experience using SCS in WCB compared to non WCB patients. Methods: A retrospective analysis of 71 WCB patients assessed and treated at the St Pauls Hospital neuromodulation program between 2016-2021 was performed. This group was compared to a cohort on non WCB patients in terms of the likelhood of being offered a trial, proceeding with trial if offered, and the likelhood of a successful trial proceeding to implant. Results: Compared to non WCB, the WCB patients were more likely to be offered a trial (86% vs 77%) and more likely to proceed with a trial if offered (82% vs 71%). Trial to implant ratios were similar in both WCB and non WCB patients (78% vs 77%). Conclusions: WCB patients were more likely to be offered a SCS trial and more likely to accept if offered, compared to non-WCB patients. However, both groups were similar in trial to implant probability.