rothman 3Speaker Dr. Ronald Crossno, Chief Medical Officer of Kindred at Home, opened his presentation with a poll asking the audience several questions, including how many of them are dealing with chronic pain. The answer was 30%, which is very similar to the percentage of people in the general population who are affected.

He then asked how many people in the audience know someone who has an opioid misuse disorder. The number went up to 75%. These responses reflect what Dr. Crossno calls “the crises of pain management.” Specifically, that we do not manage pain well--whether it’s acute or chronic—and that with opioid prescriptions nearly tripling between 1999 and 2011, we are facing an epidemic of opioid misuse.

crossno 3Crossno said the reason for this crisis has its roots in decisions made more than 400 years ago. To reconcile discoveries in science and medicine with the teachings of the church, the Western world left the realm of the body to doctors and scientists, and left the mind or spirit to the church.

This dualism encouraged medical thinking in terms of pathophysiologic causes and organ-based diseases, but neglected looking at the whole person. Dualism, Dr. Crossno emphasizes, is rare in non-Western medicine approaches, which treat the mind and the body as a whole and use a more holistic approach.

slide 2To better manage pain and reduce opioid abuse, Dr. Crossno said providers will need to understand that pain exists on two levels, the physical pain and the mental pain, and that opioids should not be the go-to answer for managing all pain. He notes that treatments are very different for acute pain versus chronic pain, or for patients recovering from an injury versus those in their final weeks.

Crossno’s first bit of advice is that doctors and other clinicians must listen to the patient. He recommends the approach “trust, but verify.” In other words, listen to the patient, but also learn from the medical records, assess the pain systemically, and observe what triggers the pain and what interventions are working.

audience 6Also, it’s important to listen to others on the care team, Crossno said. In fact, he’s a big proponent of the interdisciplinary team approach, which utilizes the expertise, training, and perspectives of clinicians from a variety of disciplines to help create a more complete picture of the patient. It is believed that this approach leads to more effective treatment plans.

Ultimately, Dr. Crossno asked clinicians to go against a Western approach that has been in place for centuries. The effort is worth it, he said, with benefits for the patients, their families, and the healthcare system as a whole. 


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*Each year the Kindred Clinical Impact Symposium focuses on a topic to enhance clinical practice in the post-acute continuum and to maintain Kindred as a leader in clinical excellence. This eighth symposium focuses on pain management across the continuum. At this week’s symposium, held in Louisville, Kentucky, national speakers discuss these topics broadly, while internal speakers bring it home to Kindred attendees from across the country.