Interdisciplinary Pain Team

Preceptors: Dr. Rosanne Schipani and Kelcie Duesler, MSN, PMHNP-BC

Interdisciplinary Pain Team

Pain Team is an Interdisciplinary Consultative Service offered to Primary Care. PCPs may refer Veterans with chronic pain for an intensive evaluation to get recommendations for comprehensive pain care. The team consists of Interventional Medicine, Rehab/ Physiatry, Psychiatry, Pharmacy, Pain Psychology, and Peer Specialty. NP residents in the pain team rotation will work with the pain team psychiatrist and psychiatric nurse practitioner to provide consultation for Veterans experiencing chronic pain and comorbid mental health or substance use concerns as the psychiatry representative of the team. NP residents also participate on the pain review team who are responsible for Opioid Safety Initiative (OSI) reviews and electronic consultation to primary care providers. OSI reviews are chart reviews of Veterans identified by the VA’s Stratification Tool for Opioid Risk Mitigation (STORM) tool as very high risk of having an adverse event, suicide or overdose event related to opioid prescription.

Interdisciplinary Pain Team Learning Objectives:

• Understand the relationship between biological, psychological, and social factors in the etiology and presentation of chronic pain conditions. And their treatment including understanding the role of untreated mental health conditions and lack of pain self-management coping strategies on prognosis.  
• Perform an assessment of the safety and potential effectiveness of long-term opioid therapy to treatment chronic pain given the new Centers for Disease Control and Prevention (CDC) guidelines and deliver feedback to patients on the risks and potential benefits of long-term opioid therapy (including the effect of opioid dosing) – also using the Stratification Tool for Opioid Risk mitigation (STORM) tool as necessary.  
• Summarize and identify the spectrum of aberrant medication-taking behaviors and generate a differential diagnosis. 
• Understand the options for non-opioid pain management including self-management and engagement in multimodal pain care treatments, as well as the rationale for these   strategies. Also understand the rationale behind optimal management of mental health and substance use disorders in improving the overall pain experience and long-term outcomes.
• Enhance learners’ ability to understand and identify risks associated with long-term chronic opioid therapy and the impact of opioid use disorder on chronic pain conditions.
• Based on assessment, recommend evidenced-based options regarding opioid use to the pain care team regarding possible treatment plans including: 1)non-opioid pain care strategies, 2) structured opioid trial, 3) prescription opioid taper, or 4) transition to partial agonist and other evidenced-based treatments of opioid use disorder. 
• Consult and collaborate with other disciplines and professionals in the management of patients with chronic pain including patients who are either at risk for or experiencing poor outcomes related to long-term opioid therapy. 
• Utilize a Whole Health, patient-centered conceptualization to develop non-opioid pain management treatment plans including engagement in multimodal pain care treatments, developing self-management skills, and optimizing management of mental health and substance use disorders.