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VA Healthcare System Serving Ohio, Indiana and Michigan


Pain Management Helps Veterans

Dr. Ali Mchaourab and patient James Bridges hold a medical model of the spinal column

Cleveland VA Pain Management Clinic Director Dr. Ali Mchaourab and patient James Bridges hold a medical model of the spinal column. Bridges agreed to alternative pain management practices of education, therapy and having a spinal cord stimulator implanted to help relieve his chronic pain. The results allowed Bridges to have more mobility and eliminated his reliance on a wheelchair.

By Paula L. Pedene, APR
Friday, March 20, 2015

Providing Veterans excellent care in pain management is taking center stage at the Louis Stokes VA Medical Center in Cleveland, Ohio. They recently earned the Clinical Center of Excellence Award from the American Pain Society for implementing a model of care where Veterans engage in a multi-disciplinary approach to treat chronic pain. Such an approach focuses on rehabilitation with all its facets, and includes interventional procedures, behavioral interventions, pharmacologic modalities and complementary/alternative medicine. By doing so, there is less reliance on opioids medication, also referred to as “narcotics”. The staff says their goal through this program is one of cultural change where they can work together to embrace clinical and behavioral services in a multi-disciplinary fashion to promote rehabilitation and self-management of pain.

“The model for culture change wasn’t just geared towards physicians and staff.” says Dr. Ali Mchaourab, Chief, Pain Medicine Service and Director, Cleveland Specialty Care Access Network (SCAN-ECHO). “It also meant spending time with our Veterans, investing in their well-being, educating and helping them see the benefits of alternative interventions and self-management and consequently, minimize the use of opioids. And perhaps most important, we implemented a cultural change across the continuum of care in the medical center, and not only in the Pain Management Center,” said Dr. Mchaourab.

In 2004, a study conducted by the Robert Wood Johnson Foundation determined that Veterans have a greater utilization rate of opioids compared to patients with similar diagnosis receiving care from the Department of Defense. After reading the study, Dr. Mchaourab and his team set out on their mission. It’s taken time, - they started their journey in 2004; but, today they have dedicated resources in clinical care at all its levels, emphasis on education for both staff and patients, funding to support their innovative programs, improved resilience among their Veteran population, and a demonstrated reduction in the use of opioids among their patients.

The unique program follows a three-level stepped-care model, based on Veterans’ need:

  • In Level-I, Veterans are managed by primary care providers with pain management training. The specialized training is provided through advanced video-teleconferencing, in which the Specialty Care Access Network-Extension for Community Health Care Outcomes (SCAN-ECHO) team leads weekly training sessions. Time is protected for the providers to attend weekly 90-minute sessions for at least a year.
  • At Level-II, Veterans are referred to outpatient pain management clinics where they can be seen by specialists in pain medicine, pain psychology, and other allied health care professionals to assist them in managing their pain.
  • Level-III is the Intensive Outpatient Program (IOP) where more complex cases are referred. In the IOP, Veterans are enrolled in a 12-week, one day/week rehabilitation program that features psychological interventions, aquatic therapy, group exercises, occupational therapy, dietary and vocational rehabilitation.

In addition to utilizing telemedicine resources to offer education to clinicians (SCAN ECHO), pain management telemedicine clinics see around 2,000 Veterans annually in The Cleveland VA, allowing Veterans to receive pain care in the facilities closest to their homes. Since 2011, the Medical Center has received more than $8 million in grant support to fund the Pain Management Center’s innovative initiatives such as SCAN ECHO and Tele-Medicine.

“I join others in offering my congratulations to Dr. Mchaourab and his colleagues.” said Dr. Carolyn M. Clancy, Interim Under Secretary for Health. She added “This is one of the most important things to get right for Veterans.”

“The Louis Stokes Cleveland VA Healthcare System has a strong history of groundbreaking innovations to improve healthcare delivery” says Cleveland VA Medical Center Director Susan Fuehrer. “Our achievement as a Center of Excellence in Pain Management exemplifies our commitment to leverage new models of care in concert with the Institute of Medicine’s Triple Aim of better care, better health and lower per capita costs,” she added.

Dr. Mchaourab is perhaps most proud of the way he has seen the program positively impact the lives of our Veterans. He likes to share a story of patient James Bridges, a 72-year-old Veteran who has been under his care for nine years. Bridges had a spinal cord stimulator implanted in 2010. He says that Bridges was concerned about tapering off and stopping opioids medications started in the private sector. But then, after proper evaluation, education, and offering alternative therapies for pain management, Bridges is another great success story.

“I had a 4-level lumbar laminectomy in 2007. The surgery was not as successful as I had hoped. In 2010, after trying medications and epidurals, Dr. Mchaourab offered me spinal cord stimulation and I agreed to try it. Five years after having my stimulator surgery, I can honestly say, Dr. Mchaourab gave me my life back. He took me from being confined to a wheelchair to being able to do yard work, and even build a shed. I am doing more at the age of 72 than I was doing at the age of 60 without any pain medication, and I haven’t used my wheelchair since. Because of the way Dr. Mchaourab and his team handled my care, I feel all my needs are addressed in a timely manner. They make me feel like part of their family. I am very grateful for the continued care I receive here,” said Bridges.

In VISN 10, the VA pain management programs are connected through a community of practice network wide. The programs share quality improvement projects and best practices through a monthly Continuing Medical Education, accredited pain management, Grand Rounds training. The Pain Management Center publicizes its services through several brochures and offers patient education materials on physical and occupational rehabilitation, behavioral interventions, invasive spine intervention and spinal cord stimulation. They also offer a quarterly newsletter specifically about the IOP.

With such national attention now upon them, Dr. Mchaourab says, “I feel vindicated now that our program is getting this attention. Our hope was to reduce Veterans dependence on opioids when it was not a national focus. We created a low-opioids reliance culture not only in the pain management center but throughout our medical center. It is clear that it can be done and it is special when you achieve it. A vision, a great team and continued support from the medical center leadership has brought us here.”


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