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News from CARF
CARF…THE REHABILITATION ACCREDITATION COMMISSION
Interdisciplinary Pain Management and the Role of Case Management
Terrence Carolan, MSPT
The interdisciplinary treatment of chronic pain is an aspect of medical rehabilitation that is not as familiar to case managers as other components of the postacute spectrum of care like inpatient acute rehabilitation, outpatient medical rehabilitation, or home care rehabilitation. Interdisciplinary pain rehabilitation (IPR) is a unique approach to treating individuals with chronic pain that brings together a group of healthcare providers under one roof to provide coordinated care to address the complex needs of this patient population. This interdisciplinary team includes the person served, family members as appropriate, a physician, a pain psychologist, and a number of other healthcare providers that may include case managers, physical therapists, nurses, and occupational therapists. This team works to accomplish shared interdisciplinary goals related to function, impairment, activity limitations, participation restrictions, environmental factors, and personal factors. IPR uses a biopsychosocial approach that looks at the interconnection between biology, psychology, and socioenvironmental factors, and case managers play a vital role in coordinating care for individuals who participate in IPR programs as well as referral of these patients to IPR programs.
In the 1980s and 1990s, IPR was a common strategy for addressing the needs of persons with chronic pain, and in the mid-1990s there was a rapid and significant decrease in the number of CARF-accredited IPR programs in the United States. Payers recognized that they could use interventions like spinal injections and prescription opioids that were less expensive than IPR, and funding for comprehensive inpatient and outpatient IPR programs became harder and harder for providers to obtain. Since then, research has shown that patients who participate in IPR programs have positive outcomes without the historically negative impacts of opioid use alone. IPR routinely achieves an 85% reduction in opioid intake, and opioid tapering is included in the CARF standards for IPR. A study conducted by U.S. Department of Veterans Affairs IPR programs in 2019 found reductions of 22% in pain-related domains of functioning (eg, mobility), a 31% reduction in pain catastrophizing, and a 16% reduction in sleep difficulties. Pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to dwell on it more, and/or to feel more helpless about the experience, and increased pain catastrophizing is linked to higher levels of chronic pain, disability, and suicidal ideation.
IPR programs that are CARF accredited are committed to quality and performance improvement, including analyses of patient outcomes including medication management and achieving patient goals such as improving functional mobility, returning to work, and returning to important life roles. CARF-accredited IPR programs also carefully review no shows, drop outs, and cancellations to ensure that patients are able to participate in and benefit from all aspects of the program.
The field of IPR is expanding again, and the CARF IPR standards have been reviewed and revised by the field in 2021 to better reflect the high level of care and performance improvement that is needed to meet the needs of persons with chronic pain. It is important for all members of the healthcare spectrum to be aware of this unique field, and it can be an outstanding resource for case managers, primary care physicians, and
Terrence Carolan,
MSPT, is the Managing Director of Medical Rehabilitation in Tucson, Arizona. He is part of the medical rehabilitation team responsible for the training of CARF surveyors and for the development and revision of CARF standards.
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