Roundtable: Implementing Integrated Pain Management: Lessons from North Carolina Health Systems and Beyond

Roundtable at Duke – February 2020

On February 5, a group of key stakeholders, including Amy Goldstein, Director, AACIPM and many of our Advisory Committee members and other participating leaders, will convene in Durham, NC, as the first of a 3-part program as part of the Duke School of Medicine Opioid Program portfolio. The Duke Department of Orthopaedic Surgery and the Duke-Margolis Center for Health Policy are launching a joint project to better understand how integrated pain management models are being developed and implemented in health systems and how such models can be deployed more broadly.

The Opioid Program portfolio aims to reduce the harmful impact of opioids in North Carolina through the development, implementation, and evaluation of sustainable, system-level interventions. The project, which takes place from October 2019–May 2021, will explore how health systems have effectively managed pain for their populations as well as identify the potential challenges and enabling factors that affected program implementation.

The first phase will include this Roundtable discussion and a public report summarizing the findings. Then 3-4 case studies of health systems with effective pain management programs will be reviewed and include interviews and site visits. The program will finish with a public report highlighting cross-cutting themes from the project.

The intent is to improve chronic pain management for North Carolina citizens by:

1. Addressing the current information gap on how integrated pain management models are being implemented to date;
2. Building the case for change and identifying the business case by learning from the experience of leaders who have achieved success in such programs;
3. Identifying policy barriers, such as payment reform structures, workforce, and any regulatory or financial issues, that could challenge adoption of integrated pain management.

Problem Statement
We have seen increases in unintentional opioid overdoses across the country, including in North Carolina. While there has been substantial activity on combating the opioid epidemic, many current approaches are reactive, such as prescription drug monitoring programs and prescribing guidelines for opioids. While these efforts have resulted in lower opioid prescribing rates, they do not address the underlying problem of untreated pain. In the absence of appropriate pain relief and meaningful access to non-opioid alternatives, there is rising concern that these efforts are resulting in barriers to appropriate pain management and unintended adverse consequences (e.g., overdose or suicide) for patients currently dependent on opioids.

Integrated pain management models including pharmacologic/drug therapies, psychological/behavioral care, physical therapy, complementary and integrative approaches, and other services, have been shown to effectively address the burden of pain. While there is evidence for the effectiveness of these approaches, expanding use of such models requires identifying best practices for implementation. This project will leverage the collective experience and expertise of health care leaders across North Carolina and other Southern states to identify real-world best practice approaches for the development and deployment of integrated pain management programs, as well as opportunities and strategies for scaling effective programs.