San Francisco Chronic Pain Opioid Study Starts in February

San Francisco Chronic Pain Opioid Study Starts in February

There’s a very interesting study on chronic pain treatment that is about to get underway in San Francisco.

A partnership called the Integrative Pain Management Program (IPMP), was created because of a community-identified opiate problem, as well as the recognition that addressing the complex problem of chronic pain management among vulnerable patients requires input from multiple perspectives.

The University of California San Francisco Osher Center for Integrative Medicine is partnering with the San Francisco Department of Public Health’s Tom Waddell Urban Health Center in the city’s Tenderloin neighborhood to study the effect of integrative medicine interventions on underserved patients with chronic pain.

Chronic pain, which can severely impact daily functioning and quality of life, can be difficult to manage, particularly among vulnerable populations, who have a higher prevalence of pain.

This research study will measure changes in patients’ pain intensity and health-related quality of life (physical, psychological, and social functioning), in addition to any changes in the amount of opioid medications. Data will also be collected on the number of referrals, attendance, and adherence to the program, as well as qualitative data on patient experiences and satisfaction with the program. The study will also examine the preliminary effects of the program on the healthcare providers caring for chronic pain patients, including providers’ experiences, burnout, and satisfaction.

It is scheduled to run from February through November of 2016, with three cohorts of 25 people, for three months each.

Those who study chronic pain treatment have been focused for some time on the challenge of delivering health care in rural America and this study in a dense urban area with a transient population has some potential and some challenges.

“Integrative health care relies on positioning the resources that support participation,” said Terri Lewis, PhD who studies health care delivery, particularly for chronic pain.  “If they fail to account for this factor, the results will be poor.  Persons with chronic pain face enormous barriers-financial, insurance, parsing their physical resources, and management of risk.  If they have planned for this it might be good.”

The UCSF Mount Zion Health Fund, and the San Francisco Department of Public Health, and through the National Institutes of Health/National Center for Complementary and Integrative Health (NIH/NCCIH), are funding the project.

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Authored by: Ed Coghlan

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I agree Dave, but in order to transform, we must participate. Change the vernacular, as you say.

You have to look deeper, way below the anger, the hurt, the hate, the jealousy, the self-pity, way down deeper where the dreams lie, son. Find your dream. It’s the pursuit of the dream that heals you.
~ Billy Mills (father), Oglala Lakota


Ms Cooper- We must do much more then make a start(which is how Deputy Assistant Secretary Wanda Jones characterized the National Pain Strategy in December 2015) We should seek the seim leben vollenden. We should try to perfect pain care rather then just improve it. Improving it just isnt good enough.
Just today i went to pubmed-and i searched pain and remission-and out of the over 600,000 articles on pain- less then 6000 were on remission and pain. In fact- i would say less then a 1000 artciles in pubmed on remission and pain.And so I say to you the new paradigm that you say pain doctors are interested in isnt about perfecting pain care it isnt about remission in pain care- it is still about the “lifetime pain patient’. why must we as a Nation settle for such lack of ideals, such fatalism. Amazing how some pain specialists will tell some pain “catastrophizers” to go get some CBT. And what does CBT do- in part looks for “fortune telling”. Isnt fatalistic fortune telling part of what pain specialists do by assuming-by fortune telling-that the person i pain will die with chronic pain? And where is the proof- did the pain specialists use big data to assess those patient authored texts that claim they were cured of a painful condition- of course not. Where is the research that studies those who overcame migraines, back pain, ms, fibromyalgia? And so clearly there is lack of interest in curing painful conditions. As you well know the 2011 IOm report clearly states they dont believe in cures for pain- more fortune telling. The NPS fortune tellers is based mostly on managing pain- with some prevention.
Yes, I agree that nurses would likely do a better job of pain care. I like the ideas of Rogers and Watson- i like the innovators. I like those who can travel freely and far to explore what might be possible for people in pain-but sadly pain specialists are not trying to free pain care or people in pain- they are too attached to the ways of the past. How can we set sail for unchartered waters when pain specialists are so afraid of losing sight of the mainland?
Excessive attachment to dated approaches in pain care- that is the monkey on the back of the pain specialists-why should i or anyone else encourage that? Let us admit the great limitations of the past approaches and be brave and caring enough to set sail to explore the new- however different it may be from the past. We need to take pain care to the moon- pain specialists wont even dream boldly enough to have it leave orbit. Lets not just tweak pain care- let us go down in history as caring and bold enough to transform it- for people in pain, for our Nation, and for humanity. Let us believe that the future belongs to those with beautiful dreams.

Dave, I do believe there are a number of physicians that wish to be part of a positive paradigm shift. Unfortunately, those of us in medicine, I am a retired RN, disabled and a chronic pain patient, only know what we are taught. Fortunately for me, communication, empathy, critical thinking, and a holistic approach to planning care are the building blocks of the nursing profession. I used to have physicians that wouldn’t even establish eye contract with me. Needless to say, since that was a requirement for me, I kept searching until I found one that would.

I could only wish that nursing organizations, such as those specializing with certification in pain care were the ones heading the charge. In my 65 years, I have seen many shifts in the healthcare delivery model. I am old enough to remember when CEOs of hospitals were physicians, but I am also old enough to remember the authoritarian role of physicians.

We need to remember that physicians are people, and patients, too. What’s really sad is that malpractice insurance and the feds at their backs, few are able to practice on their own. Most are owned and told what to do by corporate America and lobbyists with deep pockets. Make no mistake, all these unnecessary drug screens are because of people exercising their right to free enterprise, unfortunately at the expense of us unlucky blokes who have experienced failed surgeries, dangerous medical supplies approved as safe by our FDA, physical injuries, and diseases that affect pain.

There are many things to debate. Today, in this country, medical care is big business. I agree with a great deal of what you have to say, but we must begin somewhere.

Just because something doesn’t do what you planned it to do doesn’t mean it’s useless.
Thomas A. Edison


MS Cooper- Id like to see a pain specialists call for changing the paradigm- but frankly pain specialists remain medicocentric and stuck on foundationalism, essentialism, evidentialism, eliminative materialism, probabilism, prescriptivism,fatalism, positivism, Newtonian physics and allopathic medicine. PASTOR and PROMIS - were developed by and for doctors and are medicocentric, reductionistic and . Proof of such is easy- as neither PASTOR or PROMIS a salience assessment- nor the concerns of the individuals. None of the components of PASTOR even recognize PTED nor what the person in pain is most concerned about.
I understand how hard it is for pain specialists to be willing to achieve some critical distance from past practices-but if they want to make a real departure from the past-then PASTOR and PROMIS- that’s more of the same. Just like treatment contracts and udt- it distances the doctor from the person in pain in the hopes that PASTOR is a quick and efficient way to standardize outcomes. The world isn’t as simple as pain specialists would like it to be.
In addition to PASTOR being medicocentric and reductionistic and creating further distance between people in pain and their providers- it doesn’t even meet the evidence based pyramid criteria. So even if we dismiss the person in pains need as unimportant PASTOR cannot claim to be evidence based- and neither can PROMIS. We understand that a number of pain specialists wish to standardize pain care outcome with PASTOR- and receive generous grants for such- but frankly just like “personalized medicine” has nothing to do with person- PASTOR has almost nothing to do with the person in pain. Im sure you can have some of your friends disagree with me openly in public-and I welcome the debate. My basomedial amygdala is methylated enough-and my fgf 21 is on the mark.
Real reform in pain care should include pain specialists-and I find it most interesting they are not calling for themselves to do things much different or better then they are currently doing. I think it speaks volumes about how our pain care system is not making real progress in terms of providing satisfactory care to people in pain.

I am on board with this paradigm shift. We must start treating all the effects living with perpetual pain can inflict on a person. However, finding balance can only be achieved when one has the resources to help. This does not mitigate pain, in only helps with coping, but that is a huge part of daily function in any chronic illness.

I have the same concerns as Dr. Terri Lewis. The problem with many of the guidelines we are seeing these days is availability and practical application. In a society that allows for free enterprise, pain specialists are not under any obligation to offer these helpful ancillary services. And even when they want to, they are met with the same challenges patients are, billable services. We need well designed studies on a mutimodal approach that provide evidence of improved patient outcomes. But the outcomes need to be measurable on many levels, and the outcomes need to allow for differences in what the goals are for a particular person.

Stanford is also collecting valuable data through their self-management courses, as is the VA. We can heal many aspects of our lives that are affected by perpetual pain, but so eloquently put by Dr. Lynn Webster, healing is not curing. Curing is what we hope for, but look at how long we have been looking for a cure to many diseases, MS, muscular dystrophy, cancer.

You can download the PAINS Project brief from their website or from mine. It is called The Pain Assessment Screening Tool and Outcomes Registry (PASTOR).

Only when we accept perpetual pain as a chronic illness equal to heart disease, diabetes, etc., will we see a shift. But don’t get overly excited, all those who treat any chronic illness have a fight on their hands determining billable services.

Dorian W

Sounds like a huge waste of money an sources. i used to spend a lot of time i that area of san francisco. It is filled with hookers, crack heads and junkies. there is no way this will be completed. When we have chronic pain patients that live on soc sec with out insurance, people that still take their medication as directed. they could easily go to clinics and pain mgt doctors to find a better quality candidate to do the study. AGAIN LUMPING CHRONIC PAIN PATIENTS WITH STREET JUNKIES.
These people are just so lost and out of touch with our real proplem


I think its important to know what programs are being provided and tested for pain. My concern is that programs be designed by and not just for people in pain. Of course, providers are going to claim that the programs is for people in pain. And I don’t doubt they may genuinely believe such-and that is the problem- a lack of doubt regarding professional programs and practices in pain care. The focus of government and the health care industry shouldn’t continue to be feel good programs and self-congratulatory events and programs- we have had too much of that already. We need to focus much more on doing good, then feeling good about what we do, as a society. So whether its giving grant money to researchers to study a new anti-inflammatory- or developing a new program-based on an old paradigm or a paradigm that has proved of limited effectiveness- lets try truly new ideas and programs that are a departure from the limits of the past. Lets have rapid evaluation cycles- to rapidly test new programs-and to abandon them if the results are limited. We have wasted too much time and too much life on programs and products of limited effectiveness- Its time to learn from the past ad move on for the good of people in pain. Lets rid ourselves of efforts that reflect attachment to limited results.
There is no shortage of certainty and confidence on the part of professionals and program managers- with their top-down managerialized programs and efforts. It reminds of books and programs on nutrition-and no doubt some of the madness in that field will make its way increasingly into pain care. A lot of groping in the dark by professionals-but masquerading it as a shining light, instead of the narrow light that it is.
So in contrast to the professional certainty that is flourishing in pain care- I think professionals need to doubt more, to go exploring far beyond their certainties. Failing that we wont be jumping over the shadows in pain care to create the symbols of a new day-we’d only be creating more and more moral atomism and relativism and “diet book” programs in pain care- adding to the confusion with more and more choices that are increasingly difficult to compare and access.