The integration of preventive self-management training of patients with treatment using a team with technology is a smart model of healthcare– transformative care– that can help the health care system recover from its devastating escalation of addiction and disability due to pain in recent years.Transformative care is the basis for the care of patients with pain conditions provided by the integrative pain specialists of the Minnesota Head and Neck Pain Clinic.
The interdisciplinary team is best able to provide successful care for complex by integrating self-management training with evidence-based treatment to help transform patients from pain and illness to health and well-being.Our clinic is recognized by American Pain Society designates as a Centers of Excellence in pain management.
Self-management focuses on reducing risk factors and enhancing protective actions using brief structured psychophysiological counseling, cognitive-behavioral therapy, and on-line training.
This is combined with evidence-based treatment with short-term use of medical management, physical medicine procedures, injections, and splints that are tailored to the individual needs of the patient. The specially trained telehealth coach follows up with patients by phone to support the patient in implementing self-management and achieving their goals.
The factors may be diverse and include the body (e.g., muscle, joint, or nerve conditions, posture, weak tight muscles, ), lifestyle (habits, repetitive strain, posture, lifestyle, eating, sleep), emotions (depression, fear, anxiety, anger, guilt), society (conflict, relationships, abuse, isolation, social support, secondary gain), mind (attitudes, resilience, expectation, understanding), spirit (purpose, hopes dreams, self-compassion, beliefs), and the environment (risky surrounding, disorganized, unclean, noise, pollution).
|MN Head and Neck Pain Clinic||
Common Diagnoses and ConditionO Muscle pain (myofascial, fibromyalgia) O Joint pain (arthralgia inflammation) O Joint disorder (disk displaced, arthritis) O Headache (migraine, tension-type, cluster headaches) O Nerve pain (neuropathic, neuralgia) O Ligament or tendon strain O Sleep apnea and snoring issues O Other:
Pain & Symptoms from Pain ConditionO Headache O Neck and shoulder pain O Jaw pain, clicking or locking O Ear and facial pain O Tooth and mouth pain O Back and hip pain O Knee and leg pain O Poor sleep and snoring
|Treating and Preventing Chronic Pain||
Causes: Injure or strain tissuesO Direct injury and trauma O Repeated strain to muscles and joints O Tensing habits O Postural strain with jaw, sitting, stand O Weak and tight muscles and joints
Causes: Stress that turns volume up on painO Lifestyle: sleep, diet, sitting, chemicals O Emotions: depression, anxiety, anger, shame O Social life: conflicts, isolation, work/home stress O Environment: safety, toxicity, side effects O Mind: loss of control, pessimistic, unable to cope O Spirit: low energy, loss of hope, self esteem
Thus, health care leaders including the Institute of Medicine, the National Pain Strategy, the Institute for Health Care Improvement, and the Institute for Clinical System Integration have recommended integrating care strategies that engage, educate and empower people in preventing chronic pain and addiction.1-5
The MHNPC also addresses the Institute for Health Care Improvement’s triple aim to improve the patient’s experience of care, enhance the health of the patient, and controlling the cost of health care.
However, there are many barriers for health professionals to implement transformative care with self-management training. The lack of reimbursement, time burden, and inadequate training skills coupled with the lack of care coordination, fragmented care, poor communication, and conflicting treatments each interfere with patient-centered transformative approaches in clinical practice.
The MHNPC has also has a long tradition of providing a cost-effective solution to chronic pain. The clinicians and orofacial pain specialists understand and implement many cost containment strategies in our treatment plans.
To achieve cost savings, the clinic developed treatment plans that focus on self-care, self-efficacy, and long term self-management of their pain while addressing both the physical and mental health needs of the patient.The clinic focuses on musculoskeletal health including a range of motion, strength, and conditioning to help patients return to normal functioning. The clinic also provides pain patients with a pain home to minimize the overutilization of care. All of their pain care needs can either be provided by the team of pain specialists or arranged and coordinated including care with primary care physician, on-call and emergency visits and phone and e-visits. The clinic uses specific criteria for imaging, surgery, and pharmaceuticals as indicated and encourages the use of evidence-based medications when possible. The clinic’s focus on long-term care helps prevent chronic pain and its consequences of addiction, disability, and long-term health care costs by empowering patients to self-manage their pain.
1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. National Academies Press, Washington, DC; June 29, 2011.
2. National Pain Strategy at http://iprcc.nih.gov/docs/DraftHHSNationalPainStrategy.pdf. Accessed on January 10, 2016.
3. Institute for Clinical Systems Improvement. Guidelines for Chronic Pain. https://www.icsi.org/_asset/bw798b/ChronicPain.pdf. Access Feb. 11, 2106
4. Institute for Healthcare Improvement’s (IHI) Triple Aim found at http://www.ihi.org/offerings/Initiatives/TripleAim. Accessed Feb. 11, 2016
5. Lawson K, Whitebird R, Vazquez-Benitez, G, Grossman E, Fricton JR, PACT—A Transformative Self-management Program for Chronic Pain Utilizing On-line Education and Tele-Health Coaching. 2018 International Congress on Integrative Medicine & Health (Abst)
6. Institute for Healthcare Improvement’s (IHI) Triple Aim found at http://www.ihi.org/offerings/Initiatives/TripleAim. Accessed Feb. 11, 2016.