Multidisciplinary Approach for Managing Complex Pain and Addiction in Primary Care: A Qualitative Study

• Published in: Annals of family medicine Vol. 19; no. 3; pp. 224 - 231
• Main Authors: Sokol, Randi G, Pines, Rachyl, Chew, Aaronson
• Format: Journal Article
• Language: English
• Published: Annals of Family Medicine 01-05-2021; American Academy of Family Physicians
• Subjects: Addiction; Care and treatment; Complex regional pain syndromes; Health care teams; Methods; Original Research; Primary health care; United States
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.2648

PURPOSE Primary care providers (PCPs) may feel ill-equipped to effectively and safely manage patients with chronic pain, an addiction, or both. This study evaluated a multidisciplinary approach of supporting PCPs in their management of this psychosocially complex patient population, to inform subsequent strategies clinics can use to support PCPs. METHODS Four years ago, at our academic community health safety-net system, we created a multidisciplinary consultation service to support PCPs in caring for complex patients with pain and addiction. We collected and thematically analyzed 66 referral questions to understand PCPs' initially expressed needs, interviewed 14 referring PCPs to understand their actual needs that became apparent during the consultation, and identified discrepancies between these sets of needs. RESULTS Many of the PCPs' expressed needs aligned with their actual needs, including needing expertise in the areas of addiction, safe prescribing of opioids, nonopioid treatment options, and communication strategies for difficult conversations, a comprehensive review of the case, and a biopsychosocial approach to management. But several PCP needs emerged after the initial consultation that they did not initially anticipate, including confirming their medical decision-making process, emotional validation, feeling more control, having an outside entity take the burden off the PCP for management decisions, boundary setting, and reframing the visit to focus on the patient's function, values, and goals. CONCLUSIONS A multidisciplinary consultation service can act as a mechanism to meet the needs of PCPs caring for psychosocially complex patients with pain and addiction, including unanticipated needs. Future research should explore the most effective ways to meet PCP needs across populations and health systems. Key words: chronic pain management; opioid prescribing; addiction; biopsychosocial approach; primary care physicians; interdisciplinary team; multidisciplinary approach; professional practice; practice-based research