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Integrated Pain Team Clinic

Description of the Integrated Pain Team Clinic and Outcomes:
The mission of the Integrated Pain Team (IPT) Clinic is to provide focused interdisciplinary, biopsychosocial pain care in primary care that also addresses psychological comorbidities. The interdisciplinary IPT clinic integrates and co-locates pain-trained primary care providers (PCPs) with a psychologist and pharmacist with expedited access to physical and recreational therapy.  Other PCPs are encouraged to refer patients with complex chronic pain, and over the course of weeks to months, IPT providers assume responsibility for pain care. IPT also prescribes buprenorphine to patients with chronic pain and opioid misuse.  On patient discharge, IPT providers conduct a warm hand-off back to the referring PCP for long-term pain management. The IPT team based at the SFVAMC conducts virtual pain clinical visits (using VTEL) with individual veterans and groups who present for care at their nearest VA CBOC (except Santa Rosa CBOC).
  • Patients seen in the IPT clinic show significant decreases over time in opioid risk, pain disability and anxiety related to pain (based on validated measures) compared to baseline.
  • Compared to matched controls receiving usual care, patients cared for in the IPT clinic have significant decreases in their daily dose of opioids and many more discontinue opioids in the IPT clinic compared to usual care.1
  • Clinical and administrative stakeholders interviewed throughout SFVAHCS endorsed the IPT clinic model as providing high-quality biopsychosocial pain care and made some recommendations for further improving clinical services.
In summary:
This mixed methods evaluation indicates that the IPT clinic model appears to be effective in decreasing daily opioid use, risk from opioid use, and improving pain disability and pain catastrophizing. Moreover VA clinical stakeholders endorsed the IPT model as providing high-quality biopsychosocial pain care. With additional VA funding, we are piloting Whole Health personalized Pain Care Planning and Coaching that emphasizes the use of non-pharmacologic, complimentary integrative health modalities for chronic pain. 

1. Seal, K., Becker, W., Tighe, J. et al. J GEN INTERN MED (2017). doi:10.1007/s11606-017-4047-5