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Multidisciplinary Chronic Pain Management in Primary Care: Paradox or Paradigm?


Carmit McMullen, PhD, Lynn DeBar, PhD, and Charles Elder, MD, of the Center for Health Research at Kaiser Permanente Northwest.


Pragmatic clinical trial; Coordinated care; Primary care; Embedded research; EHR; Electronic health records; Chronic pain management; Healthcare system-provider interactions; PPACT

Key Points

  • PPACT (Pain Program for Active Coping and Training) is an NIH Collaboratory Demonstration Project in the implementation phase. This cluster-randomized trial is evaluating a multidisciplinary care management approach embedded in the primary care setting for patients with chronic pain.
  • PPACT combines a number of treatment approaches, including physical therapy and behavioral health interventions. Patients are supported in taking a more active role in managing their pain, and primary care providers receive additional support and guidance in treating patients with chronic pain.
  • User-friendly EHR tools can help to alleviate the burden on the primary care provider. The EHR can give a summary of where the patient is at the outset of the program and highlight the functional goals identified with the patient.
  • The paradox is that while primary care is the most logical setting for treating medically complex patients with chronic pain, the structure, process, and staffing of primary care make the implementation of best practice interventions for such patients challenging.

Discussion Themes

How best to fit multidisciplinary pain treatment into existing organizational structures and initiatives? Who “owns” a program that spans so many departments?
Should we measure as an outcome the relationship between the primary care provider and the patient since that is what will endure after the intervention ends?
How can research help to transform the paradox into a paradigm change?

For More Information

For the latest updates and publications, visit the PPACT website.


@PCTGrandRounds, @Collaboratory1, @PCORnetwork

 Grand Rounds 10-14-16

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