Henry Ford Health shows its commitment to patients with pain by providing ongoing pain-management education for its physicians and building a pain-medicine fellowship while also committing to multimodal, multispecialty individualized treatments for pain.
“Our goal is to educate,” said Nabil Sibai, MD, an anesthesiologist and pain medicine specialist with Henry Ford Health.
“We gave grand rounds across the system,” Dr. Sibai said in an interview with the AMA. “We developed a manual for physicians and nonphysician providers on responsible opioid prescribing—how to manage it, how to monitor it, and how to taper.”
Physicians also get feedback on their prescribing and are shown how they compare with their colleagues.
Henry Ford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Care teams develop customized plans
“Probably the most common reason for pain that we see—and the most common reason that opioids are prescribed—is usually back pain,” Dr. Sibai said. “We have a lot of nonopioid pharmacological and nonpharmacological options that are minimally invasive to help manage a patient's pain.”
“In the perioperative setting, we use a lot of opioid-sparing techniques, such as regional anesthesia and certain infusions and medications to keep patients as comfortable as possible,” Dr. Sibai said.
Henry Ford Health leaders also are looking at how to use buprenorphine to manage chronic pain that necessitates opioid management.
Buprenorphine “itself is an opioid that provides good analgesia that has less of the risk factors of the full mu agonist, like morphine or oxycodone,” Dr. Sibai said.
Consistent with Henry Ford Health’s multidisciplinary approach to pain, physician champions from pain medicine, behavioral health and primary care will be trained and educated, and then serve as ambassadors for their own service lines and be resources for physicians on this path, Dr. Sibai explained.
“We've identified the physician champions, and they are meeting in groups and getting the proper training, and we'll roll it out shortly after that,” he said.
Henry Ford Health is also involved with the Overdose Prevention Engagement Network, an organization dedicated to reducing substance-use disorder-related harms that shares education and resources to strengthen person-centered prevention, treatment and recovery. Henry Ford Health has worked with the network to expand access to naloxone at three of its hospital emergency departments and throughout the system’s pharmacy.
The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website.
Fellows take multidisciplinary path
Since 2016, Dr. Sibai has been the program director for the one-year, accredited pain-medicine fellowship offered to physicians by the Henry Ford Health Department of Anesthesiology, Pain Management and Perioperative Medicine.
“We're a multidisciplinary program, so we take fellows who have a background in physiatry, neurology—in addition to anesthesia,” Dr. Sibai said. “Recently, emergency medicine, family medicine and radiology were added to the list of specialty backgrounds that could complete pain fellowships.”
In the coming year, the program will be taking its first emergency medicine resident, he added.
Fellows gain experience in managing acute and chronic cancer pain, and also train in dedicated multidisciplinary clinics focused on treating sickle cell disease and cancer pain.
They are exposed to the full spectrum of pain treatments from psychological, physical, pharmacological (including infusion therapies), complementary modalities (acupuncture, yoga, massage), injections, and other advanced interventions.
These can include interventional techniques using fluoroscopy and ultrasound guidance, epidurals, facet joint injections, medial branch blocks, radiofrequency thermocoagulation, sacroiliac joint injections, muscle and joint injections, sympathetic blocks, neurolytic treatments, vertebral augmentation, spinal cord and dorsal root ganglion neuromodulation, peripheral neuromodulation, percutaneous image-guided lumbar decompression, and intrathecal pump trials and management, according to the pain-medicine fellowship’s webpage.
“In pain medicine, there's a much wider range in the training experience that they get from one pain fellowship to the other pain fellowship,” Dr. Sibai said. “What we've tried to do is provide a well-balanced education for our fellows that contains both clinical and educational components to make sure that they're well-rounded.”
Fellows also provide pain consultation services at Henry Ford Hospital in Detroit and at outpatient satellite clinics in the suburbs.
