The problem is that the chronic pain patient may make up 10% to 20% of your patient population, but will typically take up 80% to 90% of your staff and your other resources. And while it’s important for that care to continue to be offered by the primary care provider, there has to be some type of standardized approach so that we monitor to make sure we’re doing things safely and correctly.
I think probably one of the biggest things that the primary care provider can do that we don’t do enough of is the appropriate screening for psychiatric comorbidities in our chronic pain population. In our practice, before the patient is seen by any one of the members of the pain team, they’re asked to fill out a number of different assessment tools or screening tools in order to try to identify some potentially confounding psychiatric diagnosis that we may not have known about previously. That helps with our referral process and whether or not we need to be finding help from other professionals as well. Another thing that can benefit from a standardized approach is offering pain agreements or signed informed consent in some manner or another. It will not only keep you out of trouble from a provider standpoint, but it will also enable you as a clinician to provide better patient care.