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Transformative Care for Chronic Pain and Addiction

Healing the patient and the health care system through a health coaching model
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Chronic pain is the big elephant in the room of health care. It is the top reason to seek care, the number one cause of disability and addiction, and the primary driver of health care utilization, costing more than cancer, heart disease, and diabetes.1-3

More than half of the patients who seek care for pain conditions at one month still have pain years later despite treatment, and up to 20% develop long-term disability.4-9 This delayed recovery occurs largely because practitioners do not address patient-centered risk factors, such as poor ergonomics, repetitive strain, inactivity, prolonged sitting, stress, sleep disorders, anxiety, depression, abuse, and many others that increase peripheral and central pain sensitization and lead to chronic pain.6-14

When usual care fails, clinicians and patients often escalate care to passive higher-risk interventions, such as opioids, polypharmacy, surgery, or extensive medical and dental treatment, resulting in devastating consequences including a high prevalence of disability, opioid addiction, and intractable pain.10-14

Yet, clinical trials have shown the long-term outcomes of these passive interventions are no better, and in many cases worse, than patient-centered approaches that activate and empower patients with self-management strategies such as cognitive behavioral therapy (CBT), therapeutic exercise, and mindfulness-based stress reduction.15-34

There is a need to apply an innovative model of pain care—transformative care—that integrates robust self-management training and health coaching with the best,  safest evidence-based treatments. This paper offers a discussion of the concepts and practical strategies associated with transformative care as implemented with a dynamic, new online self-management training program called Patient Aligned Care Team (PACT).

Integrating Training with Treatment

When transformative care with robust, patient-centered self-management strategies is added to evidence-based treatments as part of routine care for pain conditions, chronic pain and its consequences can be better prevented and managed.38-40 In addition, transformative care can improve long-term outcomes dramatically and reduce a patient’s dependence on the health care system, thus improving both the patient’s life and the health care system.

For this reason, healthcare leaders, including the Institute of Medicine, the National Pain Strategy, and the Institute for Clinical System Improvement, have recommended routinely integrating self-management strategies into clinical practice that engage, educate, and empower people to prevent chronic pain and addiction.1-3

With transformative care, the Institute for Healthcare Improvement (IHI) Triple Aim of improving the patient’s experience of care, enhancing the health of the patient, and controlling the cost of healthcare has the best potential to be achieved with pain conditions.

There are many barriers, however, for health professionals in implementing such transformative care. A lack of reimbursement, a significant time burden, and inadequate training, coupled with the lack of care coordination, fragmented care, poor communication, and conflicting treatments, all interfere with patient-centered transformative approaches in clinical practice. New approaches to implementing self-management as part of routine healthcare are greatly needed.

Personalized Activated Care and Training

The PACT program is designed to overcome some of these barriers and support health care providers to improve long-term outcomes of patients with pain disorders. PACT provides healthcare professionals with a simple solution to integrate evidence-based self-management training and health coaching with medical or dental treatments using an online platform (Table 1).40-56 Systematic reviews of randomized clinical trials of self-management with cognitive behavioral therapy (CBT), exercise, and lifestyle changes show significant improvement in chronic pain.17-24

Reviews of mindfulness-based stress reduction also demonstrate a significant impact in reducing chronic pain,25-28 as do reviews of meditation, relaxation, and resiliency training.29-32 In addition, reviews of social support and health coaching show that they can improve functional recovery from chronic pain.32-36 Furthermore, systematic reviews of online, self-management training programs for various conditions have shown excellent outcomes.37-41 By integrating all of these strategies within the web-based PACT training program, clinicians can better engage and empower patients to learn the skills of long-term self-management for chronic pain.

Going Beyond Patient Education

More than a patient educational tool, the PACT online program is designed to be a well-defined therapeutic pain program with a goal of helping people understand how risk and protective factors in each realm of our lives can be improved with self-management strategies to relieve and prevent chronic pain.

Based on the Chronic Care Model (CCM), which has documented efficacy for chronic conditions in many healthcare organizations, the PACT Program can help transform the patient to health by practicing self-management daily.42-48 In addition, many studies of online self-management training have demonstrated the parameters used in the PACT program to be successful in achieving high levels of engagement and effectiveness in implementing online self-management training.55-65

Last updated on: October 2, 2017
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Abuse-Deterrent Opioids: Why Rush to Judgment?
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