An Interview with Lt. Col. Joel T. Tanaka, M.D. Chief, Department of Primary Care, Evans Army Community Hospital.
According to the Institute of Medicine, the health arm of the National Academy of Sciences, approximately 116 million Americans suffer from chronic pain. America faces treatment challenges; accepted methods may work for some, but newer approaches may be the answer for all.
"Based on my clinical observations and a review of the medical literature, I suspect that this number is underreported," said Lt. Col. Joel T. Tanaka, M.D., chief of the Department of Primary Care at Fort Carson's Evans Army Community Hospital. "There are many more people in misery, living with
chronic pain."
The time healthcare providers dedicate to alleviating chronic pain and treatment costs are ever increasing, and many primary care managers prescribe multiple medications.
"This tendency for providers to reach for medications first is multifactorial, but is mostly due to lack of training, time, and an emphasis on patient satisfaction scores," said Tanaka.
Many prescribed pain medications interact with each other and possibly cause additional, more debilitating problems. Pain treatment product advertisements build patient expectations claiming to alleviate chronic pain, yet they often include disclaimers that the FDA has not verified this claim.
"These are some reasons we have had less than optimal success treating pain in the traditional fashion; unless the military and civilian medical communities begin to change this culture of polypharmacy [prescribing multiple medications] that may make things worse and not better, people will continue to needlessly suffer. Sometimes we need to consider a medication last, not first," said Tanaka.
Over the past few years, Evans Army Community Hospital leaders have taken innovative steps to move providers and patients in a new direction.
"We have pioneered chronic pain management efforts focused on the patient as an individual using a 'team of teams' approach," said Tanaka. "Having multiple specialties looking at each patient through different lenses allows for a more personalized and comprehensive evaluation and individualized treatment plans."
In the Department of Primary Care, all Family medicine, pediatric, and internal medicine clinics have transitioned into National Committee for Quality Assurance recognized Patient Centered Medical Homes (PCMH). Clinics now have personalized and proactive core teams of primary care managers and nurses, as well as integrated clinical pharmacists and behavioral health providers.
"The proximity and team concept enhances communication and promotes a multidisciplinary approach to pain management. The teams offer a personalized and evidence-based approach to the treatment of chronic pain," said Tanaka. "They focus on the patient and his or her individual functional deficits, behaviors -- including the risk of abuse, medical, and Family history as well as other factors."
In addition to the transformation to PCMH, the hospital hosts a monthly Pain School that educates patients, Family members, caregivers, medical providers, and others. With trust as a foundation, classes promote a pain management philosophy of personalized medicine through evidence-based,
safe pain management techniques.
Attendees receive an overview of the medical evidence and presentation on why a multidisciplinary team approach to chronic pain management works better than just prescribing medications. Instructors emphasize becoming more active, healthy eating, maintaining a healthy weight, the importance of sleep, and stress reduction.
"This creates an environment of mutual trust and 'patient activation'," said Tanaka. "There is no way that any system of care can work to reduce pain and increase function unless the suffering person is 'In it to win it'!"
The hospital's Pain Clinic also hosts a Functional Restoration Program for active duty Soldiers. The program provides them access to dedicated medical providers and pain educators all focused on dealing with aspects of pain management. The pain educators teach about healthy sleeping habits, coping strategies, importance of regular exercise, and other topics. Another initiative is the Short Acting Opioid (SAO) Reduction program.
"By actively engaging patients, regarding behaviors that promote pain, military and civilian providers
can effectively decrease reliance on medications, reduce risk, improve mood, increase function, and realistically help people live happier, more fulfilling lives," said Tanaka.
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