About APS

Clinical Centers of Excellence in Pain Management Awards Program

UW Health Pain Care Services/Pain Treatment and Research Center
University of Wisconsin-Madison

UW Health Pain Care Services provides compassionate, high-quality pain care across the health continuum. Multidisciplinary teams work together across inpatient and outpatient settings and departments to provide pain care to both adults and children. The Pain and Headache Clinics provide outpatient rehabilitation for persons with chronic pain. Teams of physicians, midlevel providers, rehabilitation therapists, psychologists, and nurses work to reduce pain and restore function. In the inpatient setting, interdisciplinary consultation services work with the patient’s primary treatment team to address acute pain problems, coordinate secondary consultations, and promote continuity of care. UW Health offers a full range of interventional blocks, joint injections, implants, and neuraxial analgesia for patients with all types of pain, including acute, chronic, and cancer pain. Patients also have access to both inpatient and outpatient integrative medicine, addiction medicine, palliative care, and mental health services.

In 2007, staff members distributed educational tools on headache care to all of the system’s primary care providers and to headache patients discharged from the emergency department. A regional headache symposium teaches the community how to manage this disorder. This year, the team will offer a course on pain management skills for regional primary care providers. An annual comprehensive pain board review symposium draws a national audience. The team also works with health insurers to define best-practice guidelines for pain management and procedure coverage and consults with nursing facilities and the state correctional system.

Staff members are actively involved in improving clinical care through quality improvement, pain research, and education. Members regularly share findings and experience through publication. UW Health Pain Care Services maintains a comprehensive online pain management resources index. The team’s public Web site at www.uwhealth.org/pain features pain care information, self-help documents, referral instructions, and video tutorials.

Pediatric Pain Management Center
Oregon Health & Science University/Doernbecher Children’s Hospital
Portland, OR

When children and adolescents are in pain, creative solutions are often needed. An interdisciplinary, family-centered approach supports this program’s mission to bring quality compassionate care to children with painful conditions. If families live outside the major metropolitan area, access is tackled head on by offering novel Web-based distance treatment to deliver the psychological portion of their interdisciplinary pain care.

This is how the Pediatric Pain Management Center in Portland, OR, conducts daily business for its young population with acute and cancer and noncancer chronic pain. Most patients (80%) receive inpatient treatment, while the others visit the outpatient Pediatric Chronic Pain Clinic equipped with state-of-the-art medical, complementary, and physical therapies and psychological treatment. Psychology team members also staff the Coping Clinic, providing cognitive-behavioral interventions, biofeedback, and relaxation training. Cognitive-behavioral therapy is offered through an innovative Web-based Management of Adolescent Chronic Pain (Web-MAP) program for families living in rural areas. This 8- to 10-week program teaches teens and their parents psychological techniques to better manage chronic headaches, abdominal, or musculoskeletal pain.

The Pediatric Pain Management Center is a model of clinical excellence for the Oregon Health & Science University healthcare system. Staff is instrumental in developing practice standards, pain policies, and increasing institutional pain awareness. Although the Center’s focus is on pediatric care, its team works closely with adult care providers to improve pain management for all patients system-wide and for patients receiving care in other regional healthcare systems.

The Center communicates its passion for children’s pain care through its newsletter, the Comfort Chronicle. Center staff routinely provides telephone consultations to community pediatricians who have questions about managing their patients’ pain. The Pediatric Pain Management Center also serves as a regional referral center for several community organizations, including Northwest Kaiser Permanente and Shriners Hospital for Children-Portland. Faculty members are active in industry-sponsored trials testing newly introduced drugs and therapies and in NIH-funded trials. Research outcomes are incorporated into the team’s delivery of evidence-based treatments to children living with pain.

PRIDE: Productive Rehabilitation Institute of Dallas for Ergonomics
Dallas, TX

As an outpatient pain program with a population comprising mostly workers’ compensation patients, PRIDE’s revolutionary approach to pain management provides a cost-effective solution for difficult-to-treat patients and an unrivaled 85%-90% return-to-work success rate.

PRIDE has a 25-year history of performing Functional Restoration, its own specific variant of chronic pain management that “bucks the trend” of traditional pain techniques. The program’s goals are increased function, return to work, improved quality of life, and reduced dependence on opioids. Medication management with psychotropics and the program’s functional approach permit early narcotics weaning. Interventional procedures are used infrequently and generally are limited to procedures that enhance mobility. Extensive measurement of function drives physical rehabilitation. The interdisciplinary treatment includes physical and occupational therapy, psychological counseling, disability management, and biofeedback with on-site medical direction.

Most of the patients who turn to PRIDE for help already have tried traditional pain management approaches-and exhausted their medical options-without success. PRIDE receives referrals from healthcare providers nationwide.

PRIDE’s research director, Robert Gatchel, PhD, supervises predissertation psychology students who compile research from prospectively collected PRIDE patient data. Medical Director Tom G. Mayer, MD, is active in research efforts and works with organizations like AMA and ACOEM to develop treatment and impairment guidelines on pain management issues. PRIDE helps keep pain management and functional restoration in the spotlight by continually generating relevant information on the topic, publishing more than 150 articles in medical journals and multiple books and book chapters over the past 24 years.

PRIDE’s multidisciplinary physician staff includes board-certified specialists in orthopedic surgery, physical medicine and rehabilitation, and psychiatry and pain management. PRIDE’s interdisciplinary treatment team includes nurses, nurse practitioners, physical and occupational therapists, exercise physiologists, psychologists, biofeedback specialists, vocational specialists, and disability case managers.

Stanford Pain Center, Stanford University
Palo Alto, CA

The faculty and staff at the Stanford Pain Management Center recognize that pain is a complex medical problem that can profoundly affect a sufferer’s physical and mental well-being. Despite the complexities of pain itself, the Center’s mission is simple: to help patients decrease their pain and suffering, to return patients to their maximum level of functioning and independence, to help patients restore their quality of life, and to reduce the impact of pain on society.

As ambassadors of pain management, staff members at the Center broadly disseminate information regarding novel pain management and treatment options to physician groups, hospital personnel, and the public they serve in the San Francisco Bay Area and other national and international audiences. News syndicates worldwide have featured articles and programs geared toward highlighting the Center’s innovative efforts.

Cultivating a growing body of expertise is a priority, and the Center has trained more than 70 physicians to practice multidisciplinary pain management. This allows the Center to offer the most advanced treatment options currently available in a supportive, compassionate environment. Past trainees have launched new academic and community pain centers and contributed their knowledge to prestigious academic institutions nationwide.

Among the innumerable resources available to patients and their families, the Center offers:

  • a revolutionary four-part pain management approach to ensure the most comprehensive and individually tailored diagnosis and treatment
  • the Stanford Comprehensive Interdisciplinary Pain Program, which is an inpatient program that provides pain management services for the most challenging chronic pain patients
  • weekly seminars and lectures that review current state-of-the-art and evidence-based approaches to pain treatment.

The Center’s faculty and trainees hold multiple NIH awards, foundation and industry grants, and a dedicated pain research endowment and have provided care and support for thousands of hospitalized and ambulatory patients with acute, chronic, and cancer pain problems.

Fairview Pain and Palliative Care Center
University of Minnesota Medical Center
Fairview, MN

In 1998, pain specialists and other visionaries from the University of Minnesota brought together interventional, medical, and behavioral pain services, which had existed as separate entities for more than 25 years. Now interventionalists, physiatrists, neurologists, palliative care specialists, family medicine physicians, nurses, psychologists, and physical therapists work side by side in an integrated interdisciplinary program. With a strong commitment to serving a diverse population of patients with complex medical illness, Fairview pain specialists treat the entire spectrum of pain: inpatient and outpatient, neonates to geriatric patients, acute and chronic pain, headache to neuropathic pain, and cancer pain and pain in terminal illness. They collaborate with nationally recognized specialty and research groups at the University of Minnesota and the surrounding community to ensure cutting-edge therapies are applied to the most difficult pain problems. Fairview maintains a commitment to teaching medical residents, nurses, pharmacy students, advanced practice nursing students, and medical fellows. They also serve as role models and teachers for other healthcare providers in the Twin Cities and throughout Minnesota. Team members have spearheaded system-wide safety initiatives; for example, they evaluated the use of naloxone to identify sedation events associated with the use of opioids. The information resulted in staff education, changes in system-wide order sets, and selection of safer smart pump technology for patient-controlled analgesia. Pain Center staff members have written and published When Pain Flares Up, a book for patients to aid self-care techniques.

The Center’s opioid management processes and tools are emulated throughout Minnesota, particularly its opioid agreement, monitoring policies, and patient selection tools such as the DIRE Score, which many primary care physicians use to screen candidates for long-term opioid prescribing. The Pain Service participates in national evidence-based pain guideline development for chronic pain (Institute for Clinical Systems Improvement), acupuncture (HSM), and Diabetic peripheral neuropathy pain (American Society of Pain Educators).

The Richard Barrett Pain Management Center
Dartmouth-Hitchcock Medical Center
Lebanon, NH

Providing comprehensive pain care in a rural tertiary care center has stimulated the team at Richard Barrett Pain Management Center to create innovative systems. The Center provides consultation for clinicians across New England and upstate New York, has established clinics, and delivers lectures at community hospitals. The Center is an “on-call” resource for colleagues in the community and offers financial assistance for patients in need. Children undergo procedures without fear or discomfort at the unique PainFree Program at Children’s Hospital at Dartmouth, where their pediatric and adult inpatient acute pain services system redesign has measurably improved acute pain control.

The Center faces the same challenges as other tertiary pain care centers; they have struggled—but succeeded—in enabling their patients to receive behavioral and physical medicine treatment regardless of ability to pay. Their nationally recognized Functional Restoration Program accepts patients with chronic pain and practices all useful pharmacological, procedural, and surgical modalities. The Center’s “vertical integration” Dartmouth Medical School program incorporates pain curriculum into all 4 years of training to ensure graduates have the knowledge to care for patients in pain and learn the value of multidisciplinary care.

The Center has developed Computerized Dynamic Assessment of Pain (CDAP) and Interactive Computerized Quality of Life (ICQoL) tools. Their patient- and clinician-generated Pain Outcomes Evaluation Tool (POET) database details more than 10,000 patient visits. Primary research at the Center involves the use of computers to improve pain care in adults and children. Children prefer the computerized pain measurement tool to paper and pencil; this tool has improved psychometrics and can store and display child-generated reports. Other research includes the use of opioids in noncancer pain patients, the quality-of-pain Web sites, and the acquisition of large patient databases.

The team at the Center looks forward to the future; and hopes they can continue to contribute locally and nationally to the improvement of care for patients in pain.