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Saini S, Tejani NH, Rayjade A. Striving for inclusivity: the crucial function of neurorehabilitation in the management of KIF1A syndrome. Front Neurol 2024; 15:1392858. [PMID: 38846036 PMCID: PMC11153804 DOI: 10.3389/fneur.2024.1392858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Seema Saini
- Musculoskeletal Physiotherapy Department, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Neelam Hitesh Tejani
- Pediatric Neuro-physiotherapy Department, Dr. D.Y. Patil College of Physiotherapy, D.Y. Patil Education Society, Kolhapur, Maharashtra, India
| | - Amrutkuvar Rayjade
- Orthopedic Manual Therapy Department, Dr. D.Y. Patil College of Physiotherapy, D.Y. Patil Education Society, Kolhapur, Maharashtra, India
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Lentz TA, Gonzalez-Smith J, Huber K, Goertz C, Bleser WK, Saunders R. Overcoming Barriers to the Implementation of Integrated Musculoskeletal Pain Management Programs: A Multi-Stakeholder Qualitative Study. THE JOURNAL OF PAIN 2023; 24:860-873. [PMID: 36634887 DOI: 10.1016/j.jpain.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023]
Abstract
Integrated pain management (IPM) programs can help to reduce the substantial population health burden of musculoskeletal pain, but are poorly implemented. Lessons learned from existing programs can inform efforts to expand IPM implementation. This qualitative study describes how health care systems, payers, providers, health policy researchers, and other stakeholders are overcoming barriers to developing and sustaining IPM programs in real-world settings. Primary data were collected February 2020 through September 2021 from a multi-sector expert panel of 25 stakeholders, 53 expert interviews representing 30 distinct IPM programs across the United States, and 4 original case studies of exemplar IPM programs. We use a consensual team-based approach to systematically analyze qualitative findings. We identified 4 major themes around challenges and potential solutions for implementing IPM programs: navigating coverage, payment, and reimbursement; enacting organizational change; making a business case to stakeholders; and overcoming regulatory hurdles. Strategies to address payment challenges included use of group visits, linked visits between billable and nonbillable providers, and development of value-based payment models. Organizational change strategies included engagement of clinical and administrative champions and co-location of services. Business case strategies involved demonstrating the ability to initially break even and potential to reduce downstream costs, while improving nonfinancial outcomes like patient satisfaction and provider burnout. Regulatory hurdles were overcome with innovative credentialing methods by leveraging available waivers and managed care contracting to expand access to IPM services. Lessons from existing programs provide direction on to grow and support such IPM delivery models across a variety of settings. PERSPECTIVE: Integrated pain management (IPM) programs face numerous implementation challenges related to payment, organizational change, care coordination, and regulatory requirements. Drawing on real-world experiences of existing programs and from diverse IPM stakeholders, we outline actionable strategies that health care systems, providers, and payers can use to expand implementation of these programs.
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Affiliation(s)
- Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC.
| | - Jonathan Gonzalez-Smith
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
| | - Katie Huber
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
| | - Christine Goertz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
| | - Robert Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina and Washington, DC
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Hartz SM, Culverhouse RC, Mintz CM, Ellis MS, Kasper ZA, Cavazos-Rehg P, Grucza RA, Bierut LJ, Cicero TJ. Association between recent overdose and chronic pain among individuals in treatment for opioid use disorder. PLoS One 2022; 17:e0271379. [PMID: 36441691 PMCID: PMC9704550 DOI: 10.1371/journal.pone.0271379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic pain increases risk for opioid overdose among individuals with opioid use disorder. The purpose of this study is to evaluate the relationship between recent overdose and whether or not chronic pain is active. 3,577 individuals in treatment for opioid use disorder in 2017 or 2018 were surveyed regarding recent overdoses and chronic pain. Demographics from the 2017 Treatment Episode Data Set, which includes all U.S. facilities licensed or certified to provide substance use care, were used to evaluate the generalizability of the sample. χ2 tests and logistic regression models were used to compare associations between recent overdoses and chronic pain. Specifically, active chronic pain was associated with opioid overdose among people in treatment for opioid use disorder. Individuals with active chronic pain were more likely to have had a past month opioid overdose than those with no history chronic pain (adjusted OR = 1.55, 95% CI 1.16-2.08, p = 0.0003). In contrast, individuals with prior chronic pain, but no symptoms in the past 30 days, had a risk of past month opioid overdose similar to those with no history of chronic pain (adjusted OR = 0.88, 95% CI 0.66-1.17, p = 0.38). This suggests that the incorporation of treatment for chronic pain into treatment for opioid use disorder may reduce opioid overdoses.
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Affiliation(s)
- Sarah M. Hartz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Robert C. Culverhouse
- Department of Medicine and Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Carrie M. Mintz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Matthew S. Ellis
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Zachary A. Kasper
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Richard A. Grucza
- Department of Family & Community Medicine, St. Louis University School of Medicine, St. Louis, Missouri, United States of America
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Theodore J. Cicero
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
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Ware OD, Ellis JD, Dunn KE, Hobelmann JG, Finan P, Huhn AS. The association of chronic pain and opioid withdrawal in men and women with opioid use disorder. Drug Alcohol Depend 2022; 240:109631. [PMID: 36126611 DOI: 10.1016/j.drugalcdep.2022.109631] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Approximately 2.7 million individuals in the United States had an opioid use disorder (OUD) in 2020. Chronic pain may exacerbate opioid withdrawal severity, yet most research on opioid withdrawal has not collected data on chronic pain status. Moreover, there is limited evidence that women tend to experience greater opioid withdrawal severity than men, but large, confirmatory studies on this topic have not been published. The goal of this study was to examine the roles of chronic pain and gender on opioid withdrawal severity using a large, multi-site database. METHODS Data were collected from N = 1252 individuals with OUD entering eight residential addiction treatment facilities. Demographic, drug use behaviors, and chronic pain status were collected at treatment intake, and self-reported opioid withdrawal and craving were measured at intake and 1-3 days, 4-6 days, and 7-9 days after intake. Regression analyses were used to predict withdrawal and craving severity at intake and across the four timepoints. RESULTS At intake, withdrawal was higher in persons who were older, had greater SUD severity, women, had chronic pain, and used > 1 substance (p-values ≤.007) and craving was higher in persons with greater SUD severity (p < .001) and women (p = .033). Withdrawal remained higher in women and persons with chronic pain across timepoints but decreased at a similar rate relative to comparators. CONCLUSIONS Women and persons with chronic pain would benefit from earlier engagement in treatment and may require a more intensive strategy to mitigate opioid withdrawal in early treatment.
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Affiliation(s)
- Orrin D Ware
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - J Gregory Hobelmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Ashley Addiction Treatment, Havre de Grace, MD, United States
| | - Patrick Finan
- Department of Anesthesiology, University of Virginia School of Medicine, United States
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Ashley Addiction Treatment, Havre de Grace, MD, United States.
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