Managing Pain: The University of New Mexico Example & Project Echo
Editorial Staff
The University of New Mexico Pain Consultation and Treatment Center (UNM Pain Center) opened in December 2011 in response to high rates of prescription opioid deaths in New Mexico. The center provides personalized pain care to more than 10,000 patients each year, with a focus on supporting and coordinating pain care in primary care settings, extending the capacity for pain care through "Project ECHO," and coordinating with integrative therapies, including chiropractic.
The pain center acts as a "consultation clinic" and only accepts referrals from primary care providers (PCPs). The center focuses on patients with moderate to severe pain and high-impact pain, working in collaboration with PCPs. The pain center's goal is to stabilize patients and return them to their PCPs for ongoing care. This has the secondary effect of training PCPs on what types of care may be most effective for their patients.
While the percentage of patients at the center who see a chiropractic physician within the department is less than the national average, many of the patients have chiropractors outside the center. The main barrier is that Medicaid does not cover chiropractic services. The New Mexico Chiropractic Association is currently in discussions with the Human Services Department to establish a pilot project to allow for Medicaid reimbursement. Once the funding is in place, it will increase access to chiropractic for those with Medicaid – 40 percent of the population in New Mexico.
Another barrier is the relative lack of providers in the state. Thirty-one of the 33 counties in New Mexico are underserved with respect to all providers. Hundreds of new chiropractors will be required once Medicaid funding is in place.
One of the key aspects of the UNM Pain Center is Project ECHO (Extension for Community Health Outcomes). The Program for Chronic Pain started in 2008 to enable UNM providers to educate clinicians across the region on best practices for pain management through didactic and case-based training. ECHO has expanded to include participants from more than 9,000 cities in over 180 countries. The goal is to reach 1 billion people throughout the world by 2025.
Thus far, at least eight chiropractic physicians have been involved. The more chiropractic physicians are involved in ECHO presentations, the more opportunity to suggest patients get treated by a chiropractor near them.
Dr. Michael Pridham is a DC currently involved with the UNM Pain Center. He serves in the UNM Health Science Center Human Research Protections Office, on its Institutional Review Board and as a Scientific Community Member. Reflecting on the past few years, he observes, "The profession has been benefiting from the work within the UNM Pain Center by increasing the number of providers who are knowledgeable about what chiropractic physicians do. I frequently get questions such as, 'Do chiropractors treat sciatica?' and statements such as, 'I didn't know chiropractors can treat vertigo.' Being in the department increases the awareness of the conditions that we treat. Our presence in the department shows the new providers that our profession is up to the challenge of treating complex painful conditions."
As he looks towards the future, Dr. Pridham notes: "I believe that there will be endless opportunities for chiropractic physicians at the UNM Pain Center, and throughout the hospital. We have had Dr. George Simmons working within the Center For Life for more than a decade. Dr. Lucy Whyte Ferguson has worked in the Pain Department for years and she is now working on a study of using myofascial therapy and adjustments for children with scoliosis. Dr. Kenzo Kase and I have presented courses on [kinesiology taping] at Project ECHO. Others, such as Dr. James Lehman, pioneered the field of working in hospital groups decades ago in New Mexico. My vision is to have an entire chiropractic medicine department and to have residencies for newly graduated chiropractors, and even for well-seasoned practitioners."
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
