The COVID-19 pandemic has accelerated the use of digital technologies to facilitate interactions between patients and providers. One area where technology is making a major difference is in supporting the behavioral health of patients with chronic pain.
In recent years, the medical field has become more aware of the relationship between chronic pain and behavioral health. Chronic pain is associated with adverse health outcomes and substance use disorders, which can require costly healthcare treatments to address. Pain treatments designed to mitigate potential behavioral health issues can improve outcomes and subsequently lower costs.
To better understand the intersection between mental health and chronic pain — and the role of new technologies to improve care for patients and providers alike — Becker’s Spine Review recently spoke with two experts on chronic pain management and mental health, respectively:
- S. Kyle Young, MD, Commonwealth Pain & Spine in Louisville, Ky., and Evansville, Ind. Dr. Young specializes in pain management and anesthesiology.
- Amanda Brooks, Senior Integrated Care Consultant with NeuroFlow, and managing principal of Brooks Integrated Health Solutions. Ms. Brooks is a licensed clinical social worker who has executed integrated mental health and care management programs.
Dr. Young and Ms. Brooks discussed emerging trends in chronic pain treatment, the link between pain management and behavioral health, the role of new technologies to better support patients with chronic pain, and the benefits of these technologies for both patients and providers.
Multidisciplinary care; a key trend in pain management
In the world of pain management, Dr. Young explained the shift away from using opioids for most chronic pain conditions. As a result, pain management is going back to the idea of multimodal, multidisciplinary pain care, which involves collaboration between interventional pain specialists, surgeons, physical therapists and mental health providers. Ms. Brooks agrees, seeing a greater focus on holistic, integrated care for patients with chronic pain is essential to improving pain outcomes.
"Care providers, especially those in a non behavioral health setting, are becoming more aware of the benefits of delivering integrated, holistic care," Ms. Brooks said.
Other trends include shifting from reactive care to a more proactive mode of identifying and monitoring at-risk patients. Certain technologies can help providers intervene before patients become higher risk and inevitably more costly to care for.
Chronic pain and mental health are strongly linked
Chronic pain is often not well understood. Dr. Young stated, "A lot of folks who aren’t in the pain space, even physicians, think of chronic pain as an uncomfortable sensation when people have an injury or tissue damage. In reality, that is not what chronic pain is."
Dr. Young termed chronic pain, "a complex neuropsychosocial phenomenon," where a patient’s pain, mental health, and social situation are all bundled together. "Mental health is as important as anything else when you’re managing a chronic pain patient. He continued, "We see it every day on the ground. If a patient comes into the office and their mental health issues and their chronic depression or anxiety issues are not well managed, then as a pain physician, I’m not going to be very successful, no matter what interventions are offered to the patient and no matter what I do."
An estimated 50 million Americans suffer from chronic pain, and people with chronic pain are four times more likely to develop depression or anxiety. "Not only does pain impact depression, but depression impacts pain," Ms. Brooks added. "We have to treat depression and pain concurrently in order for patients to be able to improve their overall wellness."
Where technology fits into the equation
During COVID-19, many healthcare providers quickly pivoted to a telehealth platform. "What that’s done for us and for most pain management providers," explained Dr. Young, "is stay in touch with patients and check in with them more regularly." He characterized telehealth as "a big game changer that has really improved patient care." Yet beyond telehealth, Dr. Young mentioned new apps and platforms that are creating a more comprehensive way for physicians to gather data about, and take care of, patients.
One such technology is NeuroFlow, a platform enabling patients to regularly answer validated questionnaires about their pain and mental health while also tracking their pain, mood, activity, sleep, and stress. Dr. Young described how he is only with a chronic pain patient for a few minutes during an appointment, providing a brief snapshot of their pain and mental health. But through the data provided by NeuroFlow, "I’m getting a more comprehensive look at how the patient is doing on the days and weeks when they’re not in front of me," he said. "I’m getting much more of a 3D picture of this patient." NeuroFlow provides relevant dashboards and reports indicating patient progress over time.
In addition to enhancing a provider’s ability to treat an individual patient, "NeuroFlow," shared Ms. Brooks, "provides the opportunity to take a population health approach to patient care. Using validated assessments and qualitative data to risk-stratify a population allows resources to be deployed more effectively to better meet the needs of the patients that we serve."
Commonwealth Pain & Spine used digital tools to conduct nearly 3,500 patient assessments in 90 days. This engagement helped the organization improve patient outcomes by reducing patient depression symptoms by 59 percent in three months. At the same time, NeuroFlow also provides the documentation support necessary for this reimbursable care management service, Behavioral Health Integration, which contributed to an average increase of $37 in reimbursement per patient, per month.
Better digital engagement — A “win-win” patients and providers
"For most patients," Dr. Young said. “If we spend the time to show them the app, show the capabilities and what the advantages are, the vast majority of patients have been happy and pleased that we’re taking the time to ask these questions and keep up with them.”
Beyond directly impacting and improving patient outcomes, integrated care provides a host of advantages including:
1. Improving the practice’s efficiency. Because patients answer questions on the app prior to their appointment, valuable appointment time isn’t spent completing or scoring an assessment. Instead, physicians can engage with patients about their treatment plans. The data about each patient and the aggregated organization level data improves the practice’s workflow and efficiency. NeuroFlow also integrates with several EHRs. Ms. Brooks highlighted, "We’re increasing efficiencies of providers, but we’re also increasing the efficiencies of the system."
2. Increasing reimbursement. For practices, behavioral health tools facilitate documentation and billing so that providers can get reimbursed for delivering collaborative, integrated care and for checking in on a patient’s mental health. “The thing is, you’re not only providing better care,” Ms. Brooks said. "You’re opening up new revenue and profitability streams for practices."
Dr. Young, whose practice submitted an additional $70,000 in claims in just its first three months of using NeuroFlow, said, “If I can find legitimate, useful tools to help me take care of patients that are also a reimbursable event, that’s a win-win.”
3. Identifying at-risk patients. As providers enter more value-based contracts, there will be an increased focus on preventing at-risk patients from becoming high-risk patients. In Ms. Brooks’ experience, "You know who your high-risk populations are." However, "What you don’t know are the patients who are silently suffering." By using technology and data it is now possible to see trends over time and identify those patients who could move into the high-risk category — and then act proactively to assist these patients.
Digital engagement = more compassionate pain management
It’s clear that healthcare providers must act to address the many behavioral health issues endemic in society. Behavioral health events like accidental overdose or suicides can ripple through a community. Physicians treating chronic pain are uniquely positioned to help. By engaging with pain patients in a compassionate, convenient way, providers can not only improve patient outcomes, but help support the well-being of the communities they serve.
This article was sponsored by NeuroFlow.