A new study released by Yale researchers shows promising results for the treatment of patients suffering from chronic pain.
A group of researchers from the Yale School of Medicine published a study on March 23 in the journal Pain Medicine to assess the efficacy of their Opioid Reassessment Clinic, which specializes in treating patients with chronic pain who are unsafe users of prescribed opioids. Preliminary findings included that the clinic was reaching its target population and that opioid dosages were lower on average for patients after time spent treated in the clinic than upon initial referral.
“Our main goal was just to describe the clinical process that we’ve undertaken,” first author and School of Medicine professor William Becker ’95 said. “How to manage this particular complex issue is one issue all health care systems are dealing with right now, so in some ways we just wanted to explain our approach and what we do.”
Becker and the team looked at data from the first 87 patients referred to the clinic since its inception in 2012 as part of the VA Connecticut Health Care System’s West Haven Campus. Notably, 84 percent of the clinic’s patients had some history of substance use disorder, and 70 percent were misusing opioids prescribed for pain.
“This type of collaborative clinic is feasible, effective and personally, very fulfilling,” corresponding author and professor of psychiatry Ellen Edens said. “Providers are satisfied, patients are generally satisfied and we are helping patients understand what safe, effective opioid use and multimodal pain care look like.”
Edens said the Opioid Reassessment Clinic was founded after the VA reached out to her and other medical professionals to help them face a “crisis.” Patients had been prescribed high doses of opioids for long periods of time because it was standard practice, but many of the same patients later struggled with addiction to these pain medications.
Where chronic pain patients are now is a product of the way doctors were treating pain for 20 years, Becker said.
“It’s our responsibility to undo some of the problems that we created and not have the patients suffer,” he said.
The clinic attempts to mitigate these problems through a novel and multidisciplinary approach, according to the study. The clinical care team comprised of an internist, addiction psychiatrist, advanced practice nurse and health psychologist, which is why it is unique, Edens said. She also cited embedment in primary care and a short-term, rather than one-time, visit model for patients as novel aspects of the clinic.
One of the reasons the clinic is among the first of its kind is that many private health care systems see long-term chronic pain management as a poor investment, Becker said.
“Private health care systems are often just as happy to let these patents twist in the wind. It’s expensive to provide this kind of care, but the VA believes that it’s ultimately the right thing to do in the long term,” he said, adding that this approach may actually save money by addressing chronic pain head on.
Edens said she hopes the study will help educate her colleagues in the field of psychiatry that chronic pain isn’t a “black box” within their profession, and Becker stressed the importance of sharing the clinic’s model to the greater medical community so it can be scaled and adapted for local use.
Both Edens and Becker said the absence of a control group was a flaw in the design of the study.
“Because of the lack of control, we can’t tell you definitely that this is more effective than usual care — but we can describe our positive outcomes,” Edens said.
But Becker said that designating patients who are equally deserving of treatment as negative controls raises potential ethical issues.
Becker said the next steps for research on the clinic will be cost effectiveness analyses and randomized trials. He added that while a long-term dream would be nationwide implementation of this clinical model, he is more concerned with the immediate and practical goal of evaluating the necessary pieces to run a clinic that successfully addresses complex chronic pain.
An estimated 2.1 million people in the U.S. suffered from substance use disorders related to prescription opioid pain relievers in 2012, according to the Substance Abuse and Mental Health Services Administration.