The UCLA Comprehensive Pain Center recently launched a pilot program that explores interdisciplinary approaches to pain treatment and minimizes the use of prescription opioids. Spearheaded by anesthesiologist F. Michael Ferrante, MD, Director of the Comprehensive Pain Center, the pilot is a collaboration among the Department of Anesthesiology and Perioperative Medicine, the Department of Family Medicine, and UCLA Behavioral Health Associates.
The pilot program’s team includes Dr. Ferrante, addiction specialist Keith Heinzerling, MD, psychiatrist Dustin DeYoung, MD, social worker Julie Wu, LCSW, and project coordinator Kyrsten Cardenas.
The program’s first patient, referred by Dr. Heinzerling, participated in a consultation with the team on October 13. Over the course of six months, the team will coordinate a multimodal treatment plan designed to minimize the patient’s pain and dependence on opioids. Team members will gain experience collaborating on cases that present complex psychosocial, medical, and logistical challenges.
A Growing Problem, Fatal Consequences
Deaths from prescription opioids have quadrupled within the last 20 years, according to a 2016 survey by the Centers for Disease Control and Prevention (CDC). Fewer patients are chronic users of prescription opioids in the Los Angeles area than in many other regions throughout the state. Yet the CURES prescription drug database and the California Department of Public Health report that the Los Angeles County’s opioid prescription rates continue to rise, as do opioid-related trips to the emergency department, and admissions to addiction treatment programs.
Tragically, many patients are unaware of other methods to manage their pain, several of which can be more effective than opioids. “We are attempting to define whether opioids are applicable to a certain individual,” says Dr. Ferrante.
In his three decades in pain medicine, Dr. Ferrante has identified four groups of patients who seek opioids for pain management:
• Those whose long-term use of opioids effectively manages their chronic pain and doesn’t disrupt their lives
• Those who have developed opioid-induced hyperalgesia, a condition in which opioids paradoxically increase sensitivity to pain, leading to escalating doses
• Patients who use opioids to minimize psychological suffering, and who would benefit from addiction rehabilitation
• Patients with significant psychiatric disorders for whom opioid medications can be especially hazardous.
By thoroughly evaluating all aspects of the patient’s medical and social history, and observing progress over a six-month timeframe, the pilot program’s team creates an evolving treatment plan that addresses all aspects of physical and psychological suffering.
“This is a multi-faceted problem,” says Dr. Heinzerling. Once patients start to taper off opioids, “a lot of the psychosocial problems start to become a major issue, and it becomes a circle.”
Physicians and other health professionals who work in the areas of opioid dependence and chronic pain often refer patients to each other. Drs. DeYoung and Heinzerling have treated many mutual patients over the years with co-existing chronic pain and psychiatric issues.
“But we’ve been working in isolation,” Dr. Heinzerling says. The pilot program enables the professionals to confer with each other regularly, and observe how combinations of interventions may benefit the patient over time.
“We noticed the significant comorbidity with these issues and discussed the benefits of forming a treatment plan together, as the problems are usually very intertwined,” says Dr. DeYoung. “This pain pilot seemed like the best way to comprehensively address patients with chronic pain and mental health issues, while also trying to lower the amount of opioid and other potentially harmful medication the patients are on.”
The program also aims to increase patient motivation and reduce barriers to treatment. Living with chronic pain can take a psychological toll on patients, leading to a loss of hope. Care coordination included in the team approach eases the patient’s burden by providing scheduling assistance, transportation planning, help with insurance issues, and checking in with patients to encourage follow-through on the treatment plan.
Optimism and Activation
After six months, the patient and team will reassemble to discuss their experience and make recommendations for the patient’s post-pilot treatment. New patients will be added slowly, allowing time to refine practices and procedures.
And what were the results of the first meeting? The patient received a treatment plan that includes cognitive behavioral therapy, psychiatrist visits to help reduce benzodiazepine use, and consultation with a fibromyalgia specialist. “She was very activated, excited, and positive,” notes Dr. Heinzerling. “I hope we can deliver.”