Pain Study Takes Aim at $61.2 Billion Problem

Q&A talks about pain management with Dr. Daren Anderson, vice president and chief quality officer of Community Health Center, Inc.

Q: Community Health Center Inc. has received a $453,000 grant to support a new pain management study. What is the significance of the study?

A: Pain is one of the most common symptoms that lead patients to seek medical care. Our own data at Community Health Center Inc. show that up to 40 percent of our patients complain of pain. This is common in primary care settings. Both the VA and Community Health Center care for large numbers of patients with pain. But evidence suggests that primary care providers have not been well trained or equipped to manage pain, particularly chronic, long-term pain. The VA has become a center of excellence in pain research and care of patients with pain. They have developed care models that emphasize a collaborative, multidisciplinary approach to help patients with pain and provide tools and training to help primary care providers manage pain more effectively. Our study will examine how well this model can be adapted and adopted outside the VA in a community health center setting. The significance of this work is that two large, organized health systems are collaborating for the first time to share best practices and tackle a common, challenging issue in a structured, evidence-based manner.

Q: Have there been studies on the costs of chronic pain? Does it shorten life expectancy and reduce worker productivity? Can people with chronic pain be gainfully employed?

A: The answer is yes to each of these questions. Pain is enormously expensive, not just in terms of the cost of healthcare but also due to lost productivity and other factors. A recent study in the Journal of the American Medical Association estimated that lost productivity due to pain costs the U.S. $61.2 billion per year. If pain is properly managed, patients can be gainfully employed. Restoring functionality is one of the most important goals for pain care, and we actually encourage providers and patients to set specific functional goals when they embark on a course of treatment.

Q: This marks the first-ever collaboration between a federally-qualified health center and a VA Health System. Has that been achieved because of the need to study pain management? What brought the two together?

A: The VA and the Community Health Center Inc. represent two large, organized health systems, both dedicated to serving uninsured and underserved populations. It seems natural that two similar institutions such as ours would benefit from sharing best practices, learning from each other and collaborating to figure out the best way to care for patients we have in common. In addition, the VA has an extensive, highly-regarded research infrastructure with experts in a wide range of fields, including pain management, who can significantly help us study in greater depth the work we are conducting at CHC. Despite these obvious benefits, community health centers and the VA have — to a certain extent — remained in separate worlds, each focused on their own work. We are hoping with this collaboration to break down some barriers and build capacity to share and work together toward common aims.

We were brought together in this case largely through a bit of coincidence. I was the director of primary care at VA Connecticut and very involved in a study of pain management in primary care. Recently, I accepted a new position as vice president/chief quality officer the Community Health Center Inc. One of the first things I found at CHC was a very similar set of challenges regarding pain management to those I’d seen at VA, so I proposed this new study and our funder, the Mayday Fund, expressed interest and graciously agreed to fund us.

Q: The goal of the study, which begins this month and ends in November 2013, is to establish a model for managing chronic pain for CHC’s 12 sites in Connecticut, as well as community health centers across the U.S. Why is the management of chronic pain just now getting this level of attention?

A: Pain management is receiving greater attention now because of the increasing realization of its impact on our population. Pain is often under-recognized and under-treated, and even when recognized the treatments we use are often not completely effective. Pain takes an enormous toll on a patient’s quality of life and can lead to many additional problems, such as substance abuse and depression. There is also growing realization of the negative impact that opioid medications, such as oxycodone and morphine, can have on patients, families and communities if not used properly and monitored carefully.