Evaluation of an Interdisciplinary Approach to Treating Chronic Pain in Women Veterans at a Veterans Administration Medical Center

Primary care providers are often uneducated on how to effectively treat and manage chronic pain, yet they prescribe 20 percent of all narcotics given for pain (Manubay, Muchow & Sullivan, 2011). Managing chronic pain with an interdisciplinary approach is a more successful treatment, especially as narcotic pain medications lose effectiveness over time and have many adverse effects (Brennan, 2013). Another reason that interdisciplinary pain groups are successful in treating chronic pain is that they address both the physical and emotional components of pain as well (Burns, Delparte, Ballantyne & Boschen, 2013). Women veterans are a unique population when it comes to chronic pain. It has been shown that women veterans suffer in greater numbers from chronic pain, have more comorbid diseases that exacerbate chronic pain, and utilize outpatient resources 27% more than their male veteran counterparts (Kaur, Stechuchack, Coffman, Allen & Bastian, 2007). Within the VA healthcare system, narcotic prescription use has risen 270% in the last 12 years, and veterans are two times as likely to experience overdose and death from narcotics than the general population (Glantz, 2013). An interdisciplinary pain group within a Women's Clinic at a VA Hospital in the United States recently began. The group includes primary care, pharmacy, and psychology. The group's goals are to decrease patients' chronic pain and increase patients' daily function. The policy implications if this group is successful include expanding the program to male veterans and also rural veterans via tele-health. As this is a new group, it is imperative that an evaluation tool be implemented to determine if goals are being met, which is the focus of this project. The objectives for this project are: 1) Determine an appropriate tool for evaluation of an interdisciplinary pain group; 2) Implement the tool to measure baseline function at the beginning of the pain group; 3) Repeat use of the tool 3 three months after initiation of pain group and analyze the difference between baseline and post-participation data; 4) Present results to the interdisciplinary pain group. Implementation of this project involved identification of a validated assessment tool of patients' pain and function. Through literature review the Brief Pain Inventory Short Form (BPI-SF) was determined to satisfy this criterion, and permission for the author to use the tool was obtained. An application to the International Review Board was submitted and approved on an exempt status, and the Veterans Administration (VA) approved the project as well. Scores of the BPI-SF at the initial education meeting and three-month quarterly review meeting were obtained and analyzed. Data analysis involved a repeated measures design, with questionnaire collection time point (x2) as the within-subjects variable, and BPI-SF score following three months participation as the dependent variable. Twelve women initially participate in the group, but only five of these women returned for the quarterly review group, and data obtained is based upon these five women. The BPI-SF was useful is showing that there was a decrease in pain severity and interference, but due to time constraints and small sample size results were not statistically significant, and more research is needed to determine the clinical significance of the program. As this is a quality-improvement project, recommendations for the pain group are to find ways to increase patient participation, continue researching effectiveness of the group, and in these studies to address other areas of effectiveness, such as if medication use is decreased or emergency room and primary care visits for chronic pain have decreased