The public health problem of chronic pain cannot be solved by sending 50 million Americans to a relatively few pain specialists. The pain medicine and primary care community rehabilitation model(PMPCCRM) proposes that pain specialists collaborate with primary care providers to address the needs of a community population. Pro-Care of Michigan overcame significant barriers to address chronic pain in a small city surrounded by suburban and rural communities. Pro-care provides educational sessions for community physicians, easy access for referrals, and a collaborative model of care.

Methods:

500 patients treated for two years were randomly selected from the Pro-Care database. After IRB approval, an adaptation of the Brief Pain Inventory, the Cumulative Pain Inventory Questionnaire, was mailed to all identified patients. 235 patients consented and answered questions by phone or mail. Pre- and –post treatment scores on pain, walkng, gender and age were compared.

Results:

Mean pain scores declined by 2.68, from 8.04(SD 1.76) to 5.36(2.22), p < 0.001. Pre-treatment pain of the 70 males was lower than the 165 females (7.70 vs. 8.20, p=0.045) as was post-treatment pain (4.78 vs 5.59, p=0.01), and declined slightly more (2.9 versus 2.59, p=0.40). Pre-treatment pain predicted post-treatment pain (Spearman correlation: rho=0.181, p=0.005). whereas neither age (rho = -0.048, p=0.46) nor change in pain (rho = -0.009, p=0.89) predicted pos-treatment pain.

After treatment, males walked more minutes(63.38 + 24.9 versus 50.49 + 29.6, p=0.002) and worked longer (54.44 + 23.7 versus 47.3 + 25.3, p=0.044) although correction for multiple comparisons retained only walking as significantly different. Over sixty percent reported over fifty percent improvement in general activity, walking, working, daily mood, and interpersonal relations.

Discussion:

These results demonstrate that a collaborative care model between pain medicine and primary care can produce impressive results and must be replicated in larger, well- controlled prospective community studies.