Take over pain management

With tragic stories of opioid and pain reliever abuse being all too common in the news, it is important to focus on why these drugs were developed in the first place: to help reduce or control patients with chronic illnesses, surgery, and dental procedures, accidents and a wide range of physical illnesses. To ensure proper prescription regimens for medical and dental conditions, UConn Health has been a proactive leader in pain management education, leadership, and awareness, in the clinic and in the classroom.

Two pain management specialists from UConn School of Dental Medicine (SDM), Drs. Elias Chatah and Seema Kurup, and Helena Hilario, Quality Improvement Advisor, focused on a multidisciplinary, multidimensional approach to pain management and substance abuse prevention that includes new programs for students in dentistry and residents, as well as provider training, working with state and federal agencies, and creating related tools for providers and students.

The challenge, say Chatah and Hilario, was to identify the educational gaps in pain management teachings and develop programs accordingly. As part of UConn SDM’s collaboration with the Connecticut Department of Public Health (CT DPH) on their Overdose Data to Action Grant, an environmental scan involving community health centers, dental providers from UConn and Community Dentists (offered in partnership with the Connecticut State Dental Association) was launched early in the pandemic to determine what dental practitioners wanted and needed.

Surprisingly, the team found that less than half of those surveyed felt adequately trained in pain management procedures and best practices, and only 15% of those surveyed reported universal patient screening for substance use. and the risk of substance abuse.

Dr Elias Chatah (Photo by Tina Encarnacion / UConn Health)

“We recognized the important learning opportunity that lay before us,” says Chatah. “When clinicians aren’t armed with scientific evidence, they’re reluctant to prescribe. Our goal was not to dissuade clinicians from prescribing opioids or other pain relievers when indicated, but rather to ensure they had a solid understanding of scientifically supported guidelines and protocols, alternatives, evidence-based and validated screening methods and the range of support resources available. to guide them in finding an evidence-based pain management plan for each patient.

As a result, four online pain management training modules are in their final stages of development and a series of live pain management webinars have been held. The training modules were a collaborative effort, with contributions from faculty at UConn Comprehensive Pain Center (CCPC), including Dr. Rebecca Andrews, internal medicine specialist and CCPC clinical manager, Dr. Surita Rao, psychiatrist specializing in addiction, and pharmacy specialist Dr Kevin Chamberlin alongside Chatah and Kurup.

Hilario also points out that comprehensive pain management programs have been expanded, in collaboration with the CT DPH, to include safe prescribing practices, and have been incorporated into continuing education credits required for licensure and renewals. permit. Additionally, an oral and facial pain management toolkit has been developed through this grant to support dental providers with resources for safer prescribing. CT DPH is the sole recipient of the Centers for Disease Control and Prevention Overdose Data 2’s Action grant, which has a proactive dental pain management component.

On campus, UConn’s dental and medical students attend many interdisciplinary courses in their first two years, and additional training is required before dental students begin supervised clinical practice. . Training is also provided to UConn Health and public health students, including in-depth discussions on pain guidelines, opioid education, a pharmacology course, and substance abuse prevention.

In addition, the team collaborated with the UConn Opioid Working Group, a multidisciplinary team led by Dr. Rebecca Andrews and Dr. Marilyn Katz, both internal medicine specialists from the School of Medicine of UConn. The working group was formed in 2018, with the mission of developing an institutional policy relating to the prescription of opioids for chronic non-malignant pain and to pool the resources of health centers for alternative pain treatments. During this time, the team also developed clinical guidelines for the management of acute and postoperative oral pain, which will be incorporated into UConn’s MJF program.

Helena Hilario (Tina Encarnacion / UConn Health photo)

According to Chatah, the new general dentistry degree programs were originally created in 2018 with financial support from the Federal Health Resources and Services Administration (HRSA). The training included first-line pain relievers and how to safely prescribe opioids. This information has been continuously updated, he adds, and despite the pandemic, UConn has made great strides in pain management education.

Chatah, who also trained in pharmacology before becoming a dentist, says oral health has not been a priority since the arrival of COVID-19, as evidenced by research showing a marked increase in appointments. canceled or missed you and oral cancer screenings. Increased oral health anxiety and cancellations due to personal financial issues can lead to potential substance abuse.

Hilario began working with the UConn School of Dental Medicine in 2016 as a Quality Improvement Advisor on the Southern New England Practice Transformation Network (SNEPTN) Grant, leading several quality improvement efforts focused primarily on integration of medicine and dentistry. She coordinated the efforts of UConn Health’s Opioid Working Group and worked with medical and dental providers to monitor and facilitate safer opioid prescribing. Hilario currently holds the position of Quality Improvement Manager for the dental school and is the project leader of the MoU that the school has with CT DPH on the Overdose Data Grant to the action.

She notes that modifications are under development for the electronic health record used in dental school, including a “morphine milligram equivalent calculator”, an opioid risk screening tool and a voluntary guideline. on non-opioids that patients can fill out with their provider. Additionally, when a patient needs medication, doctors at UConn Health work with an online prescription monitoring program to see if additional medications (including other opioids) are prescribed by other providers.

Part of the DPH grant received by UConn Health, adds Hilario, has been used to develop an oral pain management consulting service, a secure provider-to-provider resource for exchanging information and determining the best courses of action. prescription. “We have all the tools and drugs we need,” she observes. “It’s about knowing how to navigate effectively, prescribe safely, and think about the variety of alternatives we can offer our patients. “

Dr Seema Kurup (Photo by Tina Encarnacion / UConn Health)

Kurup, Assistant Professor of Oral Medicine and Course Director, Orofacial Pain & TMD (Temporomandibular Joint Disorder), works with patients with chronic pain. As an example of the wide range of pain issues seen every day, she says there are more than 35 million people with DTM, a joint disorder that connects the jaw to the bones of the skull, with three million new cases diagnosed each year.

Patients who suffer for long periods of time from TMD, fibromyalgia, arthritis, and other problems also suffer from depression, anxiety, and exhaustion from sleep deprivation. They become irritable, and this has an impact on work, relationships and daily life. These patients with chronic pain are probably taking a cocktail of drugs to treat their myriad ailments, and these drugs can have many side effects.

Effective pain management, she explains, requires looking at all of a patient’s symptoms, including psychological, physical and environmental, following a multidisciplinary approach that may include a psychosocial assessment as well as a history review. medicinal and therapeutic. Often, she observes, patients bounce back and forth between different providers, seeking treatment from general practitioners, dentists, ENT specialists, neurologists, orthopedists, alternative medicine specialists and therapists to find a solution.

“It is essential to educate the public and providers about pain and neuropathic and even drug-induced symptoms, to clearly communicate the dangers of substance abuse, and to help providers and our students think outside the box. when it comes to managing pain, ”says Kurup. “The history, symptomatology, social implications and needs, all aimed at breaking the cycle of pain, need to be explored, and we need to focus on ‘conscious prescribing’ as part of the cure, as well as a diligent follow-up, coordinated care and patient education. “

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