Early pain identification & holistic care cut opioid use

Duke health's pain & wellness: Leading population health approach.


In Durham, North Carolina, many people find that their injuries heal with temporary pain relief; but, for others, pain causes long-term behavioural, physical, and mental problems. Early identification of those at risk could help them receive better care, which would decrease the abuse of opioids.

A quick two-question survey, tested at Duke’s Pain and Wellness Program, effectively identifies those prone to chronic pain. This helps in offering tailored interventions promptly, improving outcomes.

Senior author Padma Gulur, M.D., professor in the departments of Anesthesiology and Population Health Sciences at Duke University School of Medicine said, “Unlike traditional methods that reactively address chronic pain, this approach proactively provides resources to prevent the development of high-impact chronic pain, ensuring the right patient gets the right resources at the right time – before the problem escalates.”

Gulur and his team studied patients referred to Duke’s pain and wellness program. They used a two-question survey to identify those at risk of poor pain outcomes, with about 12% of patients falling into this category. 

These high-risk patients were given individualised treatment plans that included social support, behavioural health, physical therapy, and careful supervision by a pain specialist. Promoting a wholistic approach to pain management was the aim. More than half of the patients getting this all-encompassing treatment were able to successfully lower their morphine dosage in less than 30 days.

When compared to alternative chronic pain management techniques, the number of patients reducing their morphine dose climbed to 299 at 60 days and 349 at 180 days, demonstrating improved outcomes.

Dr. Gulur highlighted how early identification and intervention for those at risk of poor pain outcomes can lead to improved therapies and treatment approaches. This research suggests integrating proactive care models into broader healthcare settings could enhance outcomes through personalized pain management strategies.

Early identification of persistent pain, coupled with holistic interventions, effectively reduces opioid use. This approach highlights the importance of proactive care models in managing chronic pain and improving patient outcomes.

Journal reference:

  1. Padma Gulur, Nathan Christie et al., Duke Health Integrated Pain and Wellness Program — A Proactive Population Health Model. New England Journal of Medicine Catalyst. DOI: 10.1056/CAT.23.0308.
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