Collaborating With Primary Care Physicians: Q&A With Dr. Edward Tavel of Pain Specialists of Charleston

Pain management specialists are increasingly calling on primary care physicians to assist in treating patients with pain, according to a recent discussion at the annual meeting of the American Academy of Pain Medicine in Palm Springs, Calif.

Data shows that chronic pain affects 65 million patients in the US, but there are only 6,000 pain specialists to treat them. Among primary care practices, treatment options are lacking — a survey of 74 administrators found that two-thirds did not have pain management programs, and 59 percent had no specific guidelines in place for handling pain.

To close this gap, more pain management physicians are embracing collaborative care, in which they communicate with a patient's primary care physician to avoid a "one size fits all" style of pain treatment. Edward Tavel, MD, medical director of Pain Specialists of Charleston (Pa.), discusses the strategy and advantages behind collaborative care at his practice.

Q: Why is it beneficial for a pain management physician to collaborate with a patient's primary care physician?

Dr. Edward Tavel: The field of pain management has experienced remarkable growth and change over the last several decades — the wealth of information and technology available today is much different than what we had two or even 20 years ago. As specialists, our job is to educate and collaborate. We have to educate other health care providers so that the patient’s treatment plan benefits from the full spectrum of treatment solutions. We have to collaborate so that patients receive the most beneficial treatments.

As specialists, instead of only prescribing narcotics, we have the ability to explore more permanent treatments like spinal injections, rhizotomy or neurostimulation. Our practice has a dedicated research department, so we are able to offer patients access to clinical trials and the most advanced medications before they enter the market. If medication is the most appropriate course of pain management, our practice has a staff trained in best practice policy and procedure for medication management. That structure allows us to treat patients safely through pill counts, urine screens, SOAPP-R surveys, contracts and pain psychology.

Q: Why is this type of collaborative care important for both the patient and the physicians involved?

E.T.: There are some types of pain that can be considered "invisible" — that lack of physical symptoms can make it difficult for a primary care physician to diagnose the issue. Whether a primary care physician needs help determining the appropriate diagnosis or confirmation that their diagnosis makes sense, pain specialists have the subspecialty training and access to technology and testing that can determine or confirm proper diagnosis and treatment.

By collaborating with primary care physicians, physical therapists, neurosurgeons etc., we, as pain specialists, are able to offer providers and their patients a more comprehensive spectrum of pain care. Collaboration enables patients to have a team of physicians working to determine the most appropriate and beneficial treatment plan.

If you consider yourself a consultant to primary care physicians, you open that patient’s care treatment plan up to the possibility of more specialized, specific care.

Q: If pain management physicians don't already participate in collaborative care, how can they start?

E.T.: Start by emphasizing that the relationship is collaborative in nature — you are part of a care team designed to offer their patients relief and management of their painful conditions. Reinforce that pain management will not and should not replace the role of the primary care physician.

Related Articles on Pain Management:

3 Pain Specialists on Newly Approved Neurostimulation Treatment
Tennessee Pain Management Bill Neglects Underserved Areas, CRNA Says
TriState Pain Institute in Arizona Appoints New Pain Specialist

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