Pain Management, Opioid Safety, and PDMP (PMOP)
Pain Management – Bright Spot Stories/NewsLetters - Bright Spot Stories
VHA Pain Management - Bright Spot Stories
VISN 20 TelePain Program Serves Rural Veterans with Chronic Pain
Telehealth services offer the potential to reach Veterans with limited access to care due to common barriers. Increased access to evidenced-based treatments through telehealth is a significant step towards better health outcomes. The VISN 20 Pain Medicine and Functional Restoration Center based out of the VA Puget Sound Health Care System developed a TelePain Program using a “hub and spokes” model. The TelePain Program’s primary goal is to increase access to multimodality pain care for Veterans from rural areas of Washington, Oregon, Idaho, and Alaska. Current treatment options being offered through interactive video teleconferencing include pain education classes, group psychotherapies, acupuncture education, and opioid safety interventions. The program is expected to increase access to pain care, reduce travel burden, improve convenience for Veterans, increase opioid safety, and reduce suicide risk. VISN 20 plans to expand the program to connect more rural Veterans with care.
SCAN-ECHO Pain Program Enhances Clinical Practice and Improves Pain Treatment Outcomes
The VA’s Stepped Care Model for Pain Management (SCM-PM) underscores the importance of having primary and specialty care clinicians well-prepared to assess and manage pain effectively. One vehicle for ongoing education and training supports in primary care is Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO). SCAN-ECHO is an educational and consultation program designed to extend the reach of specialty services, such as pain management, and coordinate care with VA primary care teams. The San Francisco VA Chronic Pain Interdisciplinary SCAN-ECHO team was developed in 2014 to improve access to pain specialists and pain care provided by primary care teams. It entails pain management didactic presentations as well as consultation for providers, who can request to discuss challenging pain management cases with the expert team and receive mentoring and treatment recommendations. The team accepts consults from providers within VISN 21. Providers interested in joining the didactic series can contact Sara Librodo. A 2018 survey of SCAN-ECHO participating providers, revealed a high level of satisfaction with the team’s services. Veteran outcomes included decreased opioid dosing and improved use of medication-assisted treatment for opioid use disorder. The efforts of the SCAN-ECHO team underscore the value of an interdisciplinary approach which empowers providers to provide best-practice specialty care and improves patient outcomes.
An overview of the National Pain Management Strategy and Stepped Care Model can be found:
Yoga Wellness for Pain Management
Across the VA system, efforts are being made to increase access to non-pharmacological modalities for the management of chronic pain, including complementary and integrative health (CIH). There is promising evidence and increasing recognition of the potential value of CIH approaches for pain, such as yoga. The Portland VA has successfully implemented Yoga Wellness classes at both their main campuses and CBOCs to provide veterans with an alternative method for pain management. Classes, which are taught by a physical therapist and certified yoga instructor, combine stretching, strengthening, breathing, and mindfulness practices, and Veterans are encouraged to participate to their ability level. Yoga Wellness brings physical activity and movement to Veterans with chronic pain, increasing overall well-being and providing an interactive pain management option.
For additional information regarding the use of yoga in the treatment of chronic pain conditions, please refer to: https://nccih.nih.gov/health/yoga.
Opioid Education and Naloxone Distribution Program Minimizes Risk of Opioid-Related Adverse Events
In response to the opioid epidemic, a number of strategies have been implemented by VA to mitigate risk of adverse outcomes from opioids. Opioid Overdose Education and Naloxone Distribution (OEND) programs are among the interventions to reduce opioid-related morbidity and mortality. VA was the first healthcare system in the U.S. to implement a national OEND program in 2014. One exemplar of the nationwide OEND effort is the OEND program at the West Palm Beach VAMC. The program was spearheaded by clinical pharmacy specialists and a pharmacy resident as part of a year-long residency project and awarded the Under Secretary for Health Excellence in Pharmacy Practice Award. Their program focuses on providing education and training to patients regarding safe opioid use practices, recognition of overdose symptoms, overdose rescue response, use of naloxone, and non-opioid alternatives to pain management. West Palm Beach is now focusing OEND efforts on targeting high risk populations, including those with opioid use and substance use disorders as well as Veterans who have been identified during their hospitalization.
Additional information regarding opioid safety can be found: https://www.va.gov/PAINMANAGEMENT/Opioid_Safety/index.asp.
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