Providing individualized pain care during COVID in West Virginia

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West Virginia has suffered greatly as a result of the nation’s opioid-related overdose and death epidemic, but one West Virginia pain management clinic is embracing a “whole person” approach to help ensure patients receive optimal, individualized care.

While pain care is often fragmented for the patient due to numerous barriers and inconsistent care protocols, we strive to achieve best practices and treat the whole person,” said Rick Vaglienti, MD, Director of the West Virginia University (WVU) Medicine Center for Integrative Pain Management.and Director of Pain Medicine at WVU Hospital in Morgantown..

“We are fortunate to have a team of many health care professionals that work together under one roof to treat pain of all types,” said Dr. Vaglienti. “We have physicians, nurse practitioners and physician assistants, chiropractors, massage therapists, dietitians and exercise physiologists as well as psychologists, social workers and an addiction psychiatrist.”

The Center treats all types of acute and chronic pain, Dr. Vaglienti said. The Center has expanded its telemedicine capabilities due to COVID -19, allowing patients outside of the Morgantown area to access its services, Vaglienti said. “We are hopeful that some of the waivers allowing direct patient to provider communication will remain in place for the long haul. We’ve found that telemedicine is very helpful for behavioral health and follow-up when we perform an injection. It also has helped with some new patient visits. We have also used telemedicine for some patients receiving opioid therapy, but that is not common.”

“We see a lot of chronic pain, and we use our psychologists and social workers for counseling and coping strategies, because individuals with chronic pain often become depressed or anxious,” he said. “If you don’t treat the whole person, you have little chance at success. So we take this holistic approach to pain treatment, rather than just injections or medications.”

 

The comrehensive integrative approach, however, sometimes runs into barriers. Dr. Vaglienti also explained that insurance coverage and “hostile” utilization review for some interventions are among his patients’ greatest barriers to comprehensive care.  “Sometimes our patients need massage therapy or dietary counseling, but some insurance companies won’t cover them even when our staff spends a lot of time trying to explain a patient’s individual case.”

Dr. Vaglienti said that despite the barriers, the Center is committed to continuing its pain stewardship approach that minimizes the use of opioid medications while maximizing the integration of all evidence-based treatment options that were previously not combined during clinical care. “We know it’s not easy for all patients to access comprehensive care due to cost, travel, childcare and other realities of life. That’s why we’re trying to do this under one roof—patients with pain don’t need more barriers to care.”

Dr. Vaglienti said that his patients generally fall into one of three categories: Patients on opioids already needing maintenance or weaning; patients, whose physicians have stopped prescribing opioids either voluntarily or involuntarily; and patients with pain who could respond to not yet utilized methods of treatment in hopes of avoiding or minimizing the use of opioids.

As part of the state’s efforts to reduce opioid-related harms, WVU Medicine, one of the states largest primary health care providers, placed renewed emphasis several years ago on tailoring pain care treatment to individual patient needs.

“We use opioid therapy if called for, but we don’t use it as first-line therapy. The whole purpose here is to improve the quality of life for as many people as possible,” he said. “Opioids are interesting because if you happen to be anxious or depressed, they can make you feel better so some patients think it is treating their problem when in fact it may be masking other concerns.”

“The concept was introduced to WVU Medicine’s leadership in February of 2016 gaining leadership and guidance from the Defense & Veterans Center for Integrative Pain Management, and we were ready to go by May of 2017. That is how fast the medical school and the health system operated to get this done because it was a priority for West Virginia to help with this opioid crisis,” he said. “It took 14 months to go from concept to open — which is incredible for us.”

“Patients appreciate that our staff listens to them and actually tries to figure out what is going on,” said Dr. Vaglienti. “Sometimes physicians are seeing too many patients in too little time, so we try and take those few extra minutes to figure out what is actually happening here and then create an individual treatment plan for every patient.”

Learn more about what the AMA is doing to remove barriers to comprehensive pain care. Have you experienced any barriers to care? Do you have a story to tell? We want to hear from you: [email protected].

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