Management of Chronic Pain, Not Cancer Related in Origin, in

the
Primary Care Setting
Maegan
Introduction Bell Faculty advisor: Dr.
PurposeKathy Jo Ellison Results

Background: Pain affects everyone at some point The purpose of this project is to determine if Variable Mean Std. Dev.
implementing a multidisciplinary chronic pain Pain Location
in life, and for millions, chronic pain is a part of Age 54.3 13.4
everyday life. Primary care providers need an management approach in the primary care setting will
Gender n %
effective treatment plan for these patients. result in:
Male 4 33.3
However, many barriers to this process, such as a.) Improvement of patients pain
Female 8 66.7
knowledge deficits, fallacious beliefs, and lack of b.) Improved patient perception of pain management Hip; 8%
Head; 17%
treatment
Quality of n %
consistency regarding treatment methods, have all pain
contributed to the ongoing problem of inadequate Methods Lower Extremity; 25% described
Sharp, cutting, 2 16.7
pain management. lacerating
The target population included men and women (at Annoying, 3 25
troublesome,
PICO Question: In adult patients experiencing any least 19 years of age) with chronic pain in the primary Neck/ Back; 50% miserable,
intense,

type of chronic pain, not cancer related in origin, care setting. Outcome measures included level of pain unbearable
Dull, sore, hurting, 4 33.3
what is the best treatment approach for primary and satisfaction with treatment regimen. Following aching, heavy

care providers to employ, compared to the current informed consent, patients completed a questionnaire Other 3 25

standard of care methods, to achieve better pain examining location, quality and intensity of pain and
management and improved patient satisfaction? satisfaction of treatment. The patient and provider Pain Scores Popularity of Additional Treatment Modality
added an additional treatment modality to the current 8

Search Strategy: Search keywords were entered standard of care. After participation in the chosen
into databases, such as CINAHL, PubMed, and the treatment(s), patients were interviewed via telephone, 7
Mean
difference
Cochrane Library, yielding multiple systematic using a similar post-treatment questionnaire, to 6
in pre and Relaxation/ Meditation therapy; 6%
Medication/ Supplements; 18%
reviews, guidelines, randomized controlled trials evaluate effectiveness. Descriptive and inferential 5
post Hydrotherapy/ Whirlpool; 15%
intensity
(RCTs), descriptive studies, and expert reviews. This statistics were used to measure variables and outcome
data.
Conclusions 4 pain scores
was 3.4,
evidence was then critically analyzed to decide if a (SD 1.9), a Massage; 15%
3
change in practice was justified. t-score of
Stretching/ Exercise; 27%
Small test of change suggests instituting a 2 6.3, and a
Physical/ Occupational Therapy; 6%

multidisciplinary treatment approach within the p value of Acupuncture; 3% Yoga; 9%

Summary of Evidence: The research articles, from
the above search strategy, supported a
multidisciplinary and interdisciplinary approach to
chronic pain management, versus other treatment
modalities, such as standard of care, single modality
treatment, or no treatment. The articles also support
the usefulness of Complementary and Alternative
Medicine (CAM) therapies in the treatment of
chronic pain, and the willingness of patients to
participate in some form of CAM therapy.
Recommendations: The following are all Grade A:
Primary care providers should employ a
multidisciplinary treatment approach when
treating patients suffering from chronic pain. This
should include offering to help coordinate
additional treatment modalities for patients.
(Guzmn et al., 2001; Rosenquist et al., 2010;
Scascighini et al., 2008)
The patient and provider can enhance their
relationship by promoting an individualized
approach to treatment. Close evaluation of the
1 < 0.001.
primary care setting decreases patients pain levels,
while increasing satisfaction in treatment, compared 0
Intensity Pre (SD 1.2) Intensity Post
(SD
to their current standard of care alone. 2.2)
Patients are willing to participate in multidisciplinary
treatment modalities, to include many CAM Perception of Pain Perception of Satisfaction With Current Treatment Regimen
therapies.
Patient satisfaction increases when providers and
patients work together to coordinate an
individualized treatment approach incorporating Slightly Worse; 8%
The Same; 17%
multiple modalities of treatment to combat pain. Much Better; 33% The Same; 17%
After conclusion of the Small Test of Change (STOC),
Much Better; 50%
further suggestions for the primary project include:
Having a separate questionnaire for each Slightly Better; 25%
Slightly Better; 17%
pain location, as many chronic pain patients Better; 8%
experience multiple pain locations. Better; 25%
Monitoring the quality of pain pre and post
treatment to see if there are any changes.
Monitoring the popularity and effectiveness
Key References: of each individual modality to see what
Guzmn, J., Esmail, R., Karjalainen, K., Malmivaara, A., Irvin, E., & Bombardier, C. (2001). Multidisciplinary rehabilitation for chronic low back pain: Systematic review. BMJ, 322(7301), 1511-1516. Retrieved from
works best for certain patients and certain
http://xt5bv6dq8y.search.serialssolutions.com/?SS_LibHash=XT5BV6DQ8Y&genre=article&sid=sersol%3AuniqueIDQuery&id=11420271
pain
Rosenquist, R. W., Benzon, types/areas.
H. T., Connis, R. T., De Leon-Casasola, O. A., Glass, D. D., Korevaar, W. C., . . . Simon, D. L. (2010). Practice guidelines for chronic pain management: An updated report by the American Society of Anesthesiologists
Task Force on chronic pain management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology, 112(4), 810-833. doi: 10.1097/ALN.0b013e3181c43103

chosen treatment method and appropriate Scascighini, L., Toma, V., Dober-Spielmann, S., & Sprott, H. (2008). Multidisciplinary treatment for chronic pain: A systematic review of interventions and outcomes. Rheumatology, 47(5), 670-678. doi: 10.1093/rheumatology/ken021

opportunity to change or adjust the treatment, if