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For medical providers

Chronic pain can be hard to treat, but new research points out promising ways of treating pain.

Multiple studies have shown that holistic models work well to treat chronic pain.  More specifically, models should address the biological, psychological, and social nature of pain (or follow the biopsychosocial model). This holistic treatment encourages team-based care, where multiple disciplines manage the complexity of chronic pain.

For example, let’s consider a patient with lower back pain.

 

A primary care physician might rule out acute diagnoses, as well as treat co-occurring disorders that could make the pain worse. A psychologist might provide cognitive behavioral therapy to address the patient’s anxiety or fear of movement. Simultaneously, a physical therapist might teach the patient exercises to encourage safe movement. All providers on this care team would work collaboratively to help the patient reach functional goals, like returning to work or playing with gran

Check out the tips and resources below to learn more.

Take action

Set achievable goals

Help your patients set realistic expectations and personalized goals. Some patients will never be pain free, but treatment could improve their quality of life and help them reach their goals. 

Become trauma informed

Trauma, emotional pain, and chronic pain are deeply connected. Check out the section below to learn more about trauma-informed pain management. 

Use multidisciplinary treatment

Multidisciplinary treatment (like combining psychological therapy with physical therapy) can lessen the impact of chronic pain and help your patients reach their goals. To learn more about the evidence behind treatments, check out our literature review. 

Seek equity

Research shows that bias in health care delivery systems, as well as disparities in community resources, routinely results in different treatment of pain in people of color and women. Repeated trauma of racism and sexism can compound emotional pain, which can stand in the way of healing and recovery. As a provider, be accountable for your implicit bias and practice comprehensive pain treatment despite race or gender. As a health care leader, create new strategies to train providers in racial equity and culturally competent care.

Connections between trauma, emotional pain, and chronic physical pain

To better treat chronic pain, we need to understand the role of trauma and the connection between emotional pain and chronic physical pain.

Studies show that trauma can increase the risk of developing chronic widespread physical pain by 2 or 3 times. Brain mapping even demonstrates that chronic pain and emotional pain - such as depression - share some of the same pathways in the brain and nervous system. We also know that depression can make physical pain worse, and physical pain can make depression worse.

What is trauma-informed care? 

We provide trauma-informed care when we recognize the impact of trauma on health and respond with policies, protocols, and practices that promote healing and prevent re-traumatization. Trauma-informed pain care can improve function and quality of life by addressing the root cause and contributing factors of chronic pain. 

Chronic pain and trauma

The following five principles, guided by a commitment to equity, can help us achieve a trauma-informed health care system: choice, trustworthiness, empowerment, safety, and collaboration. This model is adapted from the Missouri Model for trauma-informed care and Alive and Well Communities.

If you are a health care leader, create policies and practices that promote the 5 principles of trauma-informed care.

For example, insurers could promote collaboration among providers as well as patient choice by reimbursing for behavioral health services and exercise therapy. Health centers could establish patient chronic pain groups that encourage peer support and empower patients to self-manage their chronic pain. Hospitals could increase charity care and take Medicaid to promote equity and ensure patients receive the health care services needed in their path to healing.  

If you are a provider, use the 5 principles of trauma-informed care to guide your care.

For example, use motivational interviewing to help empower your patients to move regularly. Use the patient-specific functional scale to promote collaboration and choice in treatment goals. To promote safety, always ask before touching a patient. Set realistic expectations to promote trust. And always strive to promote equity by thwarting implicit bias in diagnosis and treatment.

5 principles of trauma-informed care

Chronic pain management clinical tools

Use these evidence-based tools in clinic to manage chronic pain.

Opioid prescribing and pain management provider toolbox

This toolbox, created by the Saint Louis County Department of Public Health,
includes resources (such as screenings, safer prescribing practices, etc.) to care for patients with chronic pain.

New pain scale

Ditch the 0 – 10 pain scale, and use the patient-specific functional scale instead. The 0 – 10 pain scale can create the false expectation of an end goal of zero pain. The patient-specific functional scale, instead, promotes functional goals – which are tied to accomplishing meaningful daily activities despite the pain.

STarT back screening tool

This screening tool can be used to find out how likely a patient is to develop chronic pain. Learn more about the tool here.

Use these resources in your treatment plans and share them with your patients. 

YMCA

The YMCA has a financial assistance program, which is available for membership, early childcare education, swim lessons, youth sports, camp, after school care, and many other programs. Eligibility for assistance and the amount of the support given is determined on an individual basis. 

Main office: 314-436-1177

Pro-bono clinics

Physical therapy: SLU Health Resource Center Physical Therapy Clinic; free with doctor prescription; 1408 N Kingshighway Blvd, St. Louis, MO 63113;  314-534-8822

Occupational therapy: Occupational Therapy Student Stroke Clinic; for patients without insurance; 314-286-1625

Acupuncture: Community Acupuncture; sliding scale: 2006 S. 39th St., St. Louis, MO 63110; www.acustl.com; 314-772-4325   

Medical equipment

St. Louis HELP provides free home medical equipment through a recycle and reuse program. 

Main office: 636-933-9393

Community resources

Learn more about chronic pain from a glossary as well as local and national guidelines. 

Chronic pain glossary

We’re building a common language around chronic pain. Check out the link below for a glossary of terms. 

RHC chronic pain prevention and treatment policy paper

This policy statement translates federal chronic pain guidelines to a regional and statewide level to improve chronic pain treatment in St. Louis and Missouri. This document is guided by national pain strategies from the National Institutes of Health (NIH) and the Institute of Medicine (IOM), among hundreds of other articles. 

CDC guideline for prescribing opioids

This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain.

Literature and guidelines on chronic pain

beyondpainstl@stlrhc.org

Contact us to learn more about Beyond Pain STL, but please reach out to your doctor with medical questions.

©2019 Beyond Pain STL by the St. Louis Regional Health Commission.