2010 CCOE Award Recipients
Children’s Hospital Boston
Pain Treatment Service Harvard Medical School, Boston, MA
The Pain Treatment Service at Children’s Hospital in Boston, MA, is an integrated inpatient and outpatient program offering multidisciplinary chronic pain treatment with medications, cognitive-behavioral therapy, physical and occupational rehabilitation, interventional procedures, and acupuncture. An inpatient program and a day- hospital Mayo Family Pediatric Pain Rehabilitation Center provide intensive rehabilitation for children and adolescents with pain-related disability, particularly due to CRPS. A multidisciplinary headache clinic is staffed by pediatric neurologists, anesthesiologists, psychologists, nurses, and physical therapists. We collaborate in pain and symptom management with an affiliated palliative care program and with a multidisciplinary program for spasticity management using intrathecal baclofen. The Pain Treatment Service program exemplifies innovation and is a model of excellence for managing pain. The program follows APS protocols for analgesia and reduces hospital costs, including the lowest admission rates for ACL repairs and the lowest intensive care unit utilization for scoliosis surgery compared to pediatric tertiary hospital benchmarks. Day-hospital rehabilitation for CRPS has reduced costs and improved outcomes. The program has conducted a number of pediatrics “firsts”, including the first randomized controlled trial of PCA in children, the first randomized controlled trial of methadone in children, and the first case series on patterns of opioid escalation and on uses of spinal analgesic approaches for pediatric advanced malignancy. Ongoing translational research concerns development of prolonged duration local anesthetics, functional brain imaging of children with chronic pain, and study of the ontogeny of opioids and local anesthetic actions on the developing brain.
Children’s Hospital Boston sponsors the only ACGME- accredited pain medicine fellowship program in the United States with a specific pediatric focus. A clinical and research postdoctoral fellowship for pediatric psychologists emphasizes pediatric chronic pain management and cognitive behavioral therapy. Endowment funding supports postdoctoral research fellowships for translational or clinical outcomes research.
Michigan Head•Pain and Neurological Institute
Ann Arbor, MI
The Michigan Head•Pain and Neurological Institute (MHNI) is the nation’s first comprehensive head pain treatment and research center and provides intensive, balanced treatment of headache and related painful disorders. Utilizing therapeutic modalities, such as medical management, pharmacotherapy, hospitalization, cognitive behavioral therapy, biofeedback/stress management, procedural options, physical therapy and more, MHNI focuses on the treatment of headache and facial pain, back and neck pain, child and adult neurology, fibromyalgia; and head trauma. MHNI remains the first and only program of its kind to be accredited by the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities. These awards recognize staff and program excellence and apply national standards of care and operational procedures.
The Institute’s programs utilize a team approach, offering comprehensive services that dovetail with a patient’s clinical circumstance. MHNI employs a multidisciplinary team of physicians, physician assistants, psychologists/neuropsychologists, physical therapists, registered nurses, technicians, and administrative staff. In addition, MHNI utilizes several specialized clinical consultants, especially in its inpatient program. MHNI leaders are considered foremost authorities in headache/pain management and have long advocated the best interests of patients with pain to the government, the public, and professional pain societies. MHNI has sponsored and led initiatives nationally and in Michigan, including the Michigan Council on Pain and a statewide initiative entitled “Pain: It Costs, It Hurts, It Kills.”
MHNI is committed to helping the community and has provided guidance and clinical pathways for BlueCross BlueShield, Health Alliance Plan, Priority Health, Aetna, and others. The program has provided approximately 100 free community service presentations/interviews throughout Michigan and northern Ohio and worked with the American Headache Society and Michigan State University to provide educational programs for healthcare professionals. Along with Chelsea Community Hospital, MHNI provides a comprehensive and integrated system for patients with severe, debilitating, and intractable head, neck, and facial pain.
University of California-San Diego Center for Pain Medicine
La Jolla, CA
The University of California San Diego (UCSD) Center for Pain Medicine, at its six locations, provides services that include acute and chronic inpatient pain, preoperative surgical planning, regional anesthesia with ultrasound guidance, chronic outpatient management for all ages and illnesses, and palliative care. The interventional team uses image-guided procedures for joints, spine, and muscles, and offers medications. In addition, the psychological services include cognitive therapy, addiction evaluation, group therapy, mindfulness training, mediation, and patient education classes.
The UCSD Center for Pain Medicine also provides access to multidisciplinary and multimodal care through the UCSD Pain Consortium, which was created in 2006. The consortium includes representatives from anesthesiology, psychiatry and psychology, neurology, physiatry, primary care, addiction medicine, emergency room medicine, rheumatology, radiology, orthopedics, neurosurgery, and palliative care medicine. The Consortium meets quarterly to coordinate the multidisciplinary approach at UCSD.
In addition, the UCSD Center for Pain Medicine is the only pain clinic in San Diego County that treats indigent patients. Multidisciplinary rounds are conducted with the Veterans Administration in order to increase outreach efforts. All county hospice programs have immediate access to the Center for Pain Medicine for consultation, care, and procedures. The program and medical directors have been voted “Top Doc” for pain medicine many times.
An area of innovation for the Center for Pain Medicine is the Regional Anesthesia Service. It provides both neural-axial and continuous peripheral nerve catheters for both post-operative pain and chronic pain interventions. These techniques have reduced hospital stays, opioid use, and hopefully the development of chronic pain. The program has been so successful that it is expanding to Rady Children’s Hospital.
The Center is also one of the highest funded pain programs in the country. Research ranges from basic science to Food and Drug Administration clinical trials of novel analgesics. The researchers and clinical research team have monthly meetings to share information and promote new ideas. The Center also provides summaries of relevant research to patients in order to educate and inform.
University of Washington Division of Pain Medicine
The University of Washington (UW) Division of Pain Medicine is the first coordinated inter-hospital program which provides both inpatient and outpatient services in 9 programs at 5 hospitals: UW Medical Center; Harborview Medical Center; Seattle Children’s Hospital; VA Puget Sound Healthcare System; and the Seattle Cancer Care Alliance. In these programs, we provide medical evaluation with an emphasis on diagnosis, goal-setting, and follow-up by offering medical management; behavioral, rehabilitation and vocational counseling; integrative medicine and promotion of health lifestyles by pain experts certified in anesthesiology, internal medicine, neurology, primary care, psychiatry, psychology, rehabilitation and sports medicine and surgery.
The mission statement reflects the multidisciplinary focus of our Division: Predict, diagnose, and prevent pain from becoming a disabling disease. In order to predict, clinicians evaluate risks of developing chronic pain after injury, surgery, and disease; To diagnose, we pursue precision diagnosis when possible, permitting target-specific treatment while identifying obstacles to recovery; And to address prevention, providers promote patient education and encourage lifestyle changes. UW pain has enlarged the scope of its training to medical students, residents and a 2-year fellowship program for individuals seeking to deepen their clinical or basic science research.
As the birthplace of modern pain medicine, not surprisingly UW Pain faculty serve as key leaders in multiple Pain societies, editorial boards, State, Regional, National (Department of Defense, Food and Drug Administration), and International initiatives (World health Organization, International Association of Study of Pain, World Institute of Pain). UW Pain is active in patient advocacy, guiding legislature to strike a fine balance between maintaining lawful access to Pain care for all, while battling public health challenges related to abuse. UW will continue to provide compassionate Pain care, feedback to the community on patient progress and up-to-date guidance on evidence-based practice.
University of California, Davis Center for Pain Medicine
The UC Davis Center for Pain Medicine offers comprehensive and collaborative patient care, extensive education, innovative research and a strong commitment to patient advocacy and improving public policy. The program integrates these vitally broad elements to the greatest benefit of our patients and training clinicians. .Our clinical pain relief work is broad-based, due largely to our team that is diverse in their training and perspective. Our faculty is remarkable for each being specialty trained in pain management but emanating from disparate clinical disciplines including internal medicine, anesthesiology, physical medicine and rehabilitation, psychiatry, addiction medicine, pediatric pain, hospice and palliative care, radiology, psychology, pharmacology, bioethics, and meditation based stress-reduction. In fact, our program was one of the earliest academic centers to incorporate clinicians from all disciplines in our faculty as well as our fellows and other trainees. We interface with every clinical service within our health-system through direct patient care and education. This diversity reflects a culture in our program that embraces the widest spectrum of care and activities that advance our field.
Our pain team treats our community's most difficult cases of acute, cancer-related and chronic pain in both adults and children. A major priority of care is supporting our patients' within their continuity based primary network and subsequently helping primary care clinicians improve the pain care they can offer to all of their patients. Our clinicians are major educators who impact the training of our next-generation of pain medicine physicians, primary care and other specialty clinicians, nurses, psychologists, as well as patients.
The UC Davis Center for Pain Medicine is a unique and innovative program that excels in patient care, education, research and patient advocacy. It serves many patients directly and impacts many more indirectly through its broad-based work and initiatives.
Integrative Pain Center of Arizona
The Integrative Pain Center of Arizona (IPCA) is the only freestanding, unaffiliated outpatient interdisciplinary Pain Medicine program in the Southwestern United States. Through a systems thinking approach to pain management (via award winning innovation in information technology) and by careful blending of medical, behavioral and interventional services with research, teaching, and community outreach, IPCA has achieved its current level of success without university, corporate, or grant funding support.
At IPCA, expertise in anesthesiology, family medicine, neurology, occupational medicine, orthopedics, rehabilitation medicine, pain medicine, pain psychology, and alternative/complementary medicine are integrated to assure that all appropriate diagnostic and therapeutic approaches are available to our patients.
Achieving APS Centers of Excellence Status is a profound milestone for IPCA, because IPCA exists to stimulate the growth of the multidisciplinary integrative health care model nationally. Our APS Centers of Excellence status shows that it is possible to operate this model successfully- even in a highly managed care penetrated environment. We hope that our success serves to inspire many others to attempt what we have done. This year the IPCA research program is gearing up for a multiyear outcomes study comparing multidisciplinary care versus care as usual to provide data on process and clinical outcomes of the IPCA model.
Examples of IPCA’s commitment to its community include:
- IPCA team members have successfully drafted and lobbied a State Medical Society pain initiative to improve pain care throughout Arizona.
- We have partnered with the Arizona Medical Board, DEA, State Pharmacy Board, and the Federation of State Medical Boards to create the first-ever consensus “template” to document primary care visits for patients treated with opioid medication.
- Pharmacy and Medical students take advantage of one month IPCA clinical rotations.
- IPCA offers mentoring opportunities to help community medical professionals improve their comfort level treating pain.
Project Echo Chronic Pain and Headache Tele-clinic
University of New Mexico, Albuquerque, NM
Project ECHO Chronic Pain and Headache Tele-clinic offers traditional, integrative multimodal approaches to chronic, noncancer pain. (ECHO is an acronym for Extension for Community Healthcare Outcomes.) Primary care clinicians present patient cases to the interdisciplinary ECHO Pain Team via Web technology. It is in this way that rural and underserved pain patients receive evidence-based care within their own communities from their trusted and familiar primary care provider. Such providers are attuned to the needs, culture, language, and customs of patient populations in rural areas. This is particularly important because many areas of New Mexico are impoverished, vast in terms of geography, and quite varied in culture (tribal, pueblo, and Hispanic patient populations).
Travel to one of only two Interdisciplinary Pain clinics in New Mexico presents a barrier to rural patients. Access to the ECHO Pain Tele-Clinic provides expert pain management to all New Mexicans because travel is no longer a barrier.
There is no charge for the services that ECHO provides, as is funded through a Robert Wood Johnson grant. Unlike traditional telemedicine, which serves one patient per video connection, the ECHO model provides case-based learning to many primary care clinicians who participate at the same time. Rural providers become local champions of pain, and become a valuable resource to their local colleagues. This innovative model acts to multiply exponentially the efforts of the ECHO Pain team. Outcome measurement is one of the team’s main focuses, and in 2010 they will evaluate how their program impacts pain care for patients and clinicians.