Non-Opioid Pharmacologic Agents in the Treatment of Non-Cancer Chronic Pain in the Outpatient Setting

Opioid prescription related overdose deaths have increased substantially with evidence demonstrating only modest short-term benefits in chronic pain and thus represents the need to identify alternative treatments to opioids. A needs assessment performed for a federally qualified community health center revealed patients presently taking non-opioid pharmacologic agents in the treatment of chronic non-cancer pain (CNCP) needed additional education in managing multiple non-opioid medications. A targeted approach at improving patient experience and population health supporting the quadruple aim was undertaken with this project. Purpose: The purpose of this quality improvement project consisted of performing medication management visits for 28 referred patients with CNCP encompassing a focused review of all non-opioid pharmacologic agents being taken with tailored patient education completed. This alternatives to opioids region of need was targeted in support of maximizing the use of non-opioid pharmacologic agents in the first line treatment of CNCP. Interventions and Setting: Over the course of four weeks in a federally qualified community health center, twenty-five patients had completed medication management visits via telehealth, initially referred by their healthcare provider as patients in need of further non-opioid chronic pain medication management education. Each visit consisted of an introduction, visit goals overview, consent to proceed, focused review of all non-opioid pharmacologic agents taken for CNCP, tailored individualized education, and a post visit survey. Evaluation: A high incidence of polypharmacy was noted with most patients taking multiple non-opioid pharmacologic agents for CNCP with a low incidence of patients taking these medications as prescribed. The outcome measurement comprises patient knowledge based on the survey questions and a majority of the patients self-scored as agreed or strongly agreed following the visits concerning awareness of medication indicated for pain, confidence on how to take the prescribed medication and side effect profile familiarity. Discussion: Improvement opportunities continue to exist in supporting chronic pain patients, particularly in the first line treatment setting to maximize therapies and response. This project has great potential for sustainability and improvement in patient knowledge surrounding medication administration to enhance the first line non-opioid pharmacologic treatment of CNCP in all outpatient settings