The Challenges of an Integrative Pain Management Program

Multimodal, nonpharmacologic approaches are recommended as firstline treatments for pain but are often unavailable in resource-limited settings. In 2016, a multimodal pain management program was created and evaluated at Tom Waddell Urban Health primary care clinic in the Tenderloin neighborhood of San Francisco, a community experiencing high rates of opioid overdose. Dr. Hurstak, an assistant director at the San Francisco Free Clinic in California, presents some of the challenges of creating an integrative pain program.

Challenges! How do we…

• Support socioeconomically vulnerable patients experiencing high rates of pain, barriers to care, and greater risks from conventional pain treatments?
• Find treatment modalities to improve function and quality of life while also minimizing risks?
• Deliver to people dealing with housing instability and social crises?
• Treat patients with barriers to coming to appointments and engaging with treatment?
• Deliver a program that meets needs but is also efficient and sustainable, so we can continue doing it for a larger community of folks?
• Deal with comorbid opioid use disorder in our patients who are struggling with chronic pain?
• Explore other options for our patients for whom opioids are too high a risk?
• Uncover what other pharmacologic agents we have for these patients?
• Find other multimodal treatment programs for them?