Pain Management Begins with Trust

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“Chronic pain is emotionally exhausting,” shared a nurse from Tri-City Health Center when asked about the challenges her patients face. Patients frequently come to their community health center with back pain.  In the midst of the opioid epidemic, Community Health Center Network (CHCN) resolved to get safe, effective low back pain care to patients. How might we decrease back pain in our patients though simple, accessible and safe diagnosis and treatment?

CHCN Chief Medical Office Laura Miller, MD and colleagues jumped on the opportunity to sort through ideas with providers through a Center for Care Innovations (CCI) initiative.  Miller, along with Director of Community Contracting and Partnership Ella Schwartz and COO Rhonda Aubrey, participated in CCI’s Catalyst which trains leaders to apply human-centered design to organizational challenges. In the case of back pain, they began by exploring the need:

  • What are the challenges in diagnosing and treating low back pain in community health centers?
  • What is the provider experience? What is the patient experience?

For a deeper dive, the CHCN team partnered with four Tri-City providers and 5-10 patients. What they uncovered highlights the role of a trusting relationship.  “The patient must trust the provider to develop a good treatment plan, and trust takes time to establish,” said Miller. “It’s essential that providers validate pain.  Querying about the patient’s function and performing a thorough exam help build this trust.   Patients need to feel that the provider is there to help them and keep them safe.”

Patients in the focus group expressed that they are seeking more than drugs for their pain. They want to know all of their options and try various therapies such as chiropractic care, acupuncture, and stretching.

By honing in on trust, the team has reframed its approach to the back pain care puzzle. “The CCI design process has helped us focus on building providers’ capacity to develop trust and talk to patients,” said Aubrey. “Starting with a ‘good idea’ – even if it’s research-based – can’t get to a solution that is right for the people carrying out the solution. We need to understand the behaviors in the clinical setting before recommending an intervention. Otherwise, it won’t float.”

The team builds on ongoing provider education and intensive case management practice. Project ECHO, an initiative UC Davis, brought video conference mentoring in pain management to clinicians last year.  In addition, Care Neighborhood, CHCN’s intensive case management program, continues to coach patients with complex needs in medication management.