From Silos to Solidarity: Case Study of a Patient-Centered, Integrative Approach to Opioid Tapering and Chronic Pain Mitigation in a Multidisciplinary AIDS Clinic.

• Type of Material: Article
• Authors: Sara Pullen, Emory University; Vincent Marconi, Emory University; Carlos del Rio, Emory University; C. Head, Emory University; M. Nimmo, Emory University; J. O'Neil, Emory University; M. Ziebart, Emory University
• Language: English
• Date: 2021
• Publisher: Scientific Archives
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Pullen S, et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.33696/AIDS.3.012
• Title of Journal or Parent Work: J AIDS HIV Treat
• Volume: 3
• Issue: 1
• Start Page: 4
• End Page: 11
• Grant/Funding Information: Support for this work was provided by the National Institutes of Health, National Institute on Drug Abuse under [grant number L30 DA046878]. The study also received support from the Center for AIDS Research, Emory University [grant number NIH/NIAID P30 AI050409].
• Keywords: HIV; AIDS; Physical therapy; Opioids; Chronic pain

Abstract

BACKGROUND: People with HIV (PWH) are at a disproportionate risk for experiencing both chronic pain and opioid use disorder (OUD). Prescription opioid tapering is typically addressed within the "silo model" of medical care, whereby attention is focused solely on opioid addiction rather than also addressing chronic pain management, and limited communication occurs between patient and providers. OBJECTIVE: This descriptive case study examined an integrative, collaborative care model consisting of Provider, Physical Therapist (PT), and Patient aimed at decreasing chronic pain and opioid use within a multidisciplinary HIV/AIDS clinic. METHOD: A physical-therapy based model of chronic pain mitigation and physician-driven opioid tapering was implemented. The Provider, PT, and Patient worked collaboratively to address physiological pain, pain coping skills and opioid tapering. A patient case example was used to illustrate the implementation of the model for a future, larger study in the same patient population. RESULTS: This model was feasible in this case example in terms of clinic workflow and acceptability to both the Patient and Providers in this clinic. After the intervention, the Patient's pain was fully eliminated, and he had ceased all opioid use. CONCLUSION: Results of this case study suggest that utilizing an integrative, patient-centered approach to both chronic pain management and opioid tapering may be feasible within the context of a multidisciplinary HIV/AIDS clinic. Generalizability is limited by case study model; however, this gives insight into the value of a collaborative alternative compared to a "silo" model of opioid tapering and chronic pain management in preparation for a larger study.