Integrating a Clinical Pharmacist into a Multidisciplinary Pain Center: Feedback and Perspectives

Background:In January 2017, two clinical pharmacists joined our institution’s multidisciplinary pain center care team. They help optimize management of chronic pain patients. The purpose of this study is to present and discuss an innovative model of clinical pharmacy development in France.Method:A retrospective study for the period January 1, 2017 to June 30, 2019 was conducted.The care team evaluated the clinical pharmacy service using a satisfaction questionnaire.The outcome measures were the type of activities, number of interventions and healthcare team satisfaction.Results:During this period, the clinical pharmacists intervened 1839 times. Conventional clinical pharmacy activities do not represent the majority of solicitations, which shows the advantage of both adapting the activities deployed to the expectations of care teams and expanding care packages to those needs.Pharmaceutical advice was the main activity, mostly given to physicians (55%) and patients (35%).They consisted in contributing to the choice of drug strategy, explaining the treatment, adjusting a dosage, and improving relations between hospital and community caregivers.The feedback forms showed that caregivers believe that clinical pharmacy has positive impacts on patient care and healthcare team quality of life. Conclusion:The numerous requests for clinical pharmacist interventions show the care team’s significant interest in this new activity. Clinical pharmacy has shown its added value in patient quality of care and helps optimize the patient's care pathway by decompartmentalizing hospital and community medicine.This clinical pharmacy development model is innovative in France, as pharmacists are full members of the care team. Specific activities were set up progressively according to the care team’s needs. Caregivers’ expectations and requests made in clinical pharmacy progressed over time to more specialized activities. Assessment of team satisfaction showed that this model was very well accepted by caregivers and highlights the relevance of adapting and specializing clinical pharmacy development to the care team’s needs.

Evaluation of the benefits from the introduction meeting for patients with chronic non-malignant pain and their relatives in interdisciplinary pain center

BackgroundTreatment of patients with chronic nonmalignant pain (CNMP) is challenging and requires a multidisciplinary effort. In a multidisciplinary pain center, patients are treated by a team of doctor, nurse, physiotherapist, psychologist and social worker. Especially in the beginning of treatment patients receive much information. Many patients and their relatives have problems with comprehending it.ObjectiveThis is an action research study aimed to find the optimal mode for to introduce patients with CNMP and their relatives to the multidisciplinary pain treatment.MethodIn the fall of 2016, we began to invite patients and their relatives to the introduction meeting (IM), which takes place in groups of up to 20 people, has duration of 1 hour and is led by the physiotherapist and nurse, but the physician is also present. Invited patients are able to understand written and oral Danish and are not suffering from social phobias. During IM facts about the center, treatment course and pain physiology are presenter. Immediately after IM, participants are anonymously asked about their experiences.ResultsUp to date (February 2017) 254 patients were invited. Invitation was rejected by 63 patients (24,8%). Question about understanding of chronic pain was answered by 108 participants (both patients and their relatives), and 103 participants declared better understanding of chronic pain after IM end before. 69 participants answered question about understanding of treatment course in the center. All but 2 participants declared after IM at their understanding was better end before. In fact, 31 (44,9%) participants estimated changes in understanding of treatment course as much significant.ConclusionThe IM at the beginning of multidisciplinary therapy seems to be a promising activity for patients with CNMP referred to the multidisciplinary pain center, as well as for their relatives. Study is ongoing and updated results will be presented at the conference.

Low and Therapeutic Doses of Antidepressants are Associated with Similar Response in the Context of Multimodal Treatment of Pain

Background: Antidepressants are prescribed in a wide range of doses to treat both depression and chronic pain, with optimal psychopharmacology individualized for each patient. In the past decade more antidepressants from different chemical classes have become available and are being used for the treatment of both chronic pain and depression. Objective: To review the utilization pattern changes and compare response rates of different classes and doses of antidepressants for various pain conditions in the context of multimodal therapies. Design: Chart review. Methods: We reviewed 5,916 records at an outpatient multidisciplinary pain center. Of these, 379 records were for patients diagnosed with cancer pain. Because the mechanisms and treatment approaches to cancer pain can differ greatly from non-cancer chronic pain, these records were excluded from the analysis. We assessed 1,506 medical records for patients with chronic non-caner pain who had used at least one antidepressant, with the main outcome measure being the Numeric Rating Pain Scale, 0–10. Results: Of the 5,916 charts reviewed, 1,506 (25.4%) chronic non-cancer pain charts recorded the prescription of at least one antidepressant. Most patients received a combination of medications and procedures. Of the 450 patients receiving secondary amines, favorable responses were recorded for 340 (76%) patients, while 103 (23%) did not respond and 7 had unknown responses. Of the 492 patients receiving tertiary amines, favorable responses were recorded for 375 (76%) patients, while 113 (23%) did not respond, and 4 had unknown responses. Of the 533 patients receiving SSRI/SNRIs, favorable responses were recorded for 382 (72%) patients, while 147 (28%) did not respond, and 4 had unknown responses. Of the 369 patients receiving atypical antidepressants, favorable responses were recorded for 272 (74%) patients, while 94 (25%) did not respond, and 3 had unknown responses. Limitations: A retrospective study design and the use of antidepressants as a part of multimodal treatment of pain. Conclusion: The data suggest that in the context of multimodal treatment for chronic pain, antidepressant therapy at both low and therapeutic doses demonstrates similar response rates. Tricyclic antidepressants (TCAs), which include secondary and tertiary amines, as well as SSRI/SNRIs and atypicals, all appear to show similar favorable response rates. Key words: Antidepressants, chronic pain, multidisciplinary pain center, multimodal analgesia.