Dr. James Fricton, a pain specialist and professor at Minneapolis-based University of Minnesota, has worked in the pain management field for nearly three decades, and has found patient education and training is crucial to a successful pain management treatment plan.
Question: What approach(s) to pain management have you found successful?
Dr. James Fricton: Transformative care is a new model of care. The key is integrating training with treatments. As doctors, we treat patients with evidence-based treatments such as medications, therapies, injections and surgery. These treatments improve pain in most cases, but in nearly half of cases, there is a delay in recovery. This delay is typically due to risk factors associated with a patient's lifestyle factors which are under the patient's control such as repetitive strain, ergonomic issues, stress and emotional issues. We need to train patients to improve these risk factors and strengthen their protective factors such as exercise, eating and sleeping well, and maintaining positive emotions.
A transformative care model can do this in a variety of ways. In our clinic, we have health psychologists and physical therapists who act as pain coaches to teach patients what they need to do. However, in many cases, this is not a cost-effective model. Therefore, we are incorporating online training to help patients identify and control risk factors that are playing a part in the delayed recovery from their pain condition.
Q: How does this model help patients, especially as opioid addiction is rapidly increasing throughout the nation?
JF: The transformative care model may serve patients better than the passive treatments many providers are offering, which may include more addictive opioid medications. It is true that they are effective for treating acute pain, but most studies have found them to increase chronic pain over time and add many adverse side effects. Most patients on opioids for pain at one month after onset still have pain and want opioids five years later.
Doctors will discover that the use of a transformative care model as part of their daily care will dramatically increase outcomes because it addresses the lifestyle factors that play a significant role in causing delayed recovery and chronic pain. This model will also prevent chronic pain by properly managing the risk factors early on and engaging the patients in the process.
I tell my patients; "I am happy to treat the pain condition with medication and therapy but the most important part of management is reducing the cause of your pain. Eighty-percent of your success is based on what you do and 20 percent is based on my treatments. Are you interested in learning how to reduce the causes?"
Q: What challenges do pain specialists face in the coming years? What strategies can they employ to reap success?
JF: One challenge is thinking broader about managing the whole person and all of their risk factors and not just the pathophysiology of the pain disorder. This requires us to educate the patient and shift a large part of the responsibility of care onto them. We have to take on a team approach in order to sufficiently train the patient about what they need to do to improve.
Learn more from Dr. Fricton at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information.
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