Beyond medications final

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Military Workshop-3, National Rx Drug Abuse Summit, April 2-4, 2013. Military medicine's Expansion of Pain Management Treatment Options presentation by Col. Richard Petri

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Beyond medications final

  1. 1. Select SLIDE MASTER to Insert Briefing Title Here Military Workshop Beyond Medications: Military Medicine’s Expansion of Pain Management Treatment Options National RX Drug Abuse Summit Orlando, Florida COL RICHARD P. PETRI, Jr., MC William Beaumont Army Medical Center Interdisciplinary Pain Management Center 4 April 2013 Information Brief UnclassifiedCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  2. 2. Select SLIDE MASTER to Insert Briefing Title Here Disclosure Richard Petri has no financial relationships with proprietary entities that produce health care goods or services. Picture/clip art is non-copyrighted material taken off the internetCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  3. 3. Select SLIDE MASTER to Insert Briefing Title Here Learning Objectives 1.  Outline strategies to provide community level support to soldiers and their families struggling with prescription pain addiction. 2.  Plan how to establish a support group for spouses and children of military families. 3.  Identify ways to leverage partnerships to impact your community.COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  4. 4. Select SLIDE MASTER to Insert Briefing Title Here Questions •  What are the current integrative modalities used by the Department of the Army for pain management. •  Describe the tiered approach to integrative modalities for use in the Department of the Army pain management programs. •  Name five of the pillars of approach to the wholistic pain management program within the Department of the ArmyCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  5. 5. Select SLIDE MASTER to Insert Briefing Title Here Goals Understand the history of, present day usage and impact of Integrative Medicine (IM) in the United States as well as the military Identify the expansion of IM within the military over the past four years Identify several IM research projects within the DoD Understand the importance, now and in the future of IM especially as it relates to the MilitaryCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  6. 6. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  7. 7. Select SLIDE MASTER to Insert Briefing Title Here In the beginning….. The History of Alternative MedicineCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  8. 8. Select SLIDE MASTER to Insert Briefing Title Here 2000 BC “Where is my root?”COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  9. 9. Select SLIDE MASTER to Insert Briefing Title Here 1000 AD “That root is heathen, say this prayer”COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  10. 10. Select SLIDE MASTER to Insert Briefing Title Here 1850 AD “That prayer is superstition, drink this potion”COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  11. 11. Select SLIDE MASTER to Insert Briefing Title Here 1900 AD “That potion is snake oil, swallow this pill”COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  12. 12. Select SLIDE MASTER to Insert Briefing Title Here 1945 AD “That pill is ineffective, take this antibiotic”COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  13. 13. Select SLIDE MASTER to Insert Briefing Title Here AD 2000 “That antibiotic is artificial, eat this root”COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  14. 14. Select SLIDE MASTER to Insert Briefing Title Here The cycle of herbalsCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  15. 15. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Picture/clip art is non-copyrighted material taken off the internet Apr-9-13
  16. 16. Select SLIDE MASTER to Insert Briefing Title Here CAM Definition NCCAM  defines  CAM  as  a  group  of  diverse  medical  and  health   care  systems,  prac6ces,  and  products  that  are  not  generally   considered  part  of  conven8onal  medicine  as  prac8ced  by  holders  of  M.D.   (medical  doctor)  or  D.O.  (doctor  of  osteopathy)  degrees  and  by  their  allied   health  professionals  such  as  physical  therapists,  psychologists,  and  registered   nurses.     Conven8onal  medicine  is  also  known  as  Western  or  allopathic  medicine.       The  boundaries  between  CAM  and  conven8onal  medicine  are  not  absolute,  and   specific  CAM  prac8ces  may,  over  8me,  become  widely  accepted.  NCCAM  Publica8on  No.  D347.  “CAM  basics  What  Is  Complementary  and  Alterna8ve  Medicine  ?  Update  April  2010.  15  Jul  2010  <hTp://nccam.nih.gov/health/wha8scam>  COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  17. 17. Select SLIDE MASTER to Insert Briefing Title Here CAM Definitions •  Complementary medicine refers to use of CAM together with conventional medicine Example- Acupuncture for pain management. Most use of CAM by Americans is complementary •  Alternative medicine refers to use of CAM in place of conventional medicine Example-herbals instead of chemotherapy for cancer management •  Integrative medicine (also called integrated medicine) refers to a practice that combines both conventional and CAM treatments for which there is evidence of safety and effectiveness Example- Chiropractic Manipulation for low back pain •  Integrative Health and Healing is similar to Integrative Medicine but replaces the term “medicine” for “Health and Healing”; two concepts representing the goal of the practice of medicineNCCAM  Publica8on  No.  D347.  “CAM  basics  What  Is  Complementary  and  Alterna8ve  Medicine  ?  Update  April  2010.  15  Jul  2010  <hTp://nccam.nih.gov/health/wha8scam>   COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  18. 18. Select SLIDE MASTER to Insert Briefing Title Here Terminology• Conven8onal  or  Allopathic  • Complementary  and  Alterna8ve  Medicine  (CAM)  or  now  know  as  Integra8ve  Medicine  (IM)   OR• Scientifically Proven with Evidence Based Research• Unproven PracticesCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Picture/clip art is non-copyrighted material taken off the internet Apr-9-13
  19. 19. NCCAM Classification ofBriefing Title Here Select SLIDE MASTER to Insert CAM Therapies with Examples and Prevalence of Selected Modalities •  Natural Products (17.7%)* –  Herbals/Botanicals –  Supplements –  Probiotics •  Mind-body Medicine –  Meditation (9.4%)* –  Yoga (6.1%)* –  Acupuncture ** (1.4%)* –  Guided Imagery –  Hypnotherapy • Based  on  the  2007  Na6onal  Health   Interview  Survey  (NHIS)   –  Progressive Relaxation –  Qi Gong **Also  considered  part  of  Energy  ,   –  Tai Chi Manipula6ve  and  Body  Based  Methods   •  Manipulative and Body-Based methods and  TCM   –  Osteopathic and Chiropractic Manipulation (8.6%)* –  Massage (8.3%)* NCCAM  Publica8on  No.  D347.  “CAM  basics   •  Other CAM Practices What  Is  Complementary  and  Alterna8ve   –  Movement Therapies Medicine  ?  Update  April  2010.  15  Jul  2010   <hTp://nccam.nih.gov/health/wha8scam>   –  Traditional Healers –  Energy (Magnet, Light, Qi Gong, Reiki, Healing Touch) –  Whole Medical Systems (Ayurvedic, TCM)COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  20. 20. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Picture/clip art is non-copyrighted material taken off the internet Apr-9-13
  21. 21. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Picture/clip art is non-copyrighted material taken off the internet Apr-9-13
  22. 22. Select SLIDE MASTER to Insert Briefing Title Here CAM in the United States•  42.1% of patient seek CAM treatments•  72% conceal use from doctors•  83% use in combination with conventional medicine•  21.2 billions of dollars per year spent per year [1]•  More visits than to Primary Care (60M)•  “Minor” treatments include weight loss, performance enhancement, self-care, pediatrics[1] Eisenberg DM, Davis RB, Ettner SL, Appel S, et al. Trends in alternative medicine use in the United States. Journal of the American Medical Association. 1998;280: 1569-1575Updated Tindle, H., Davis, R., Phillips, R., Eisenberg, DM, Trends in Use of Complementary and Alternative Medicine by US Adults: 1997-2002. Alternative Therapies in Health and Medicine Jan/Feb 2005 Vol 11 (1), 42-49. Picture/clip art is non-copyrighted material taken off the internet COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  23. 23. Select SLIDE MASTER to Insert Briefing Title Here What is the usage of CAM in the Military?•  35% of US adults use some type of CAM [1]•  Military has a higher percentage of usage than the general public at 81% [2] [4]•  Herbal use has the highest usage [1],[2]•  Low back pain is the most common reason patients use CAM [3]•  Military personnel reported using three CAM stress-reduction therapies at 2.5-7 times the rate of civilians. [4] 1  Tindle  et  al    Trends  in  use  of  complementary  and  alterna8ve  medicine  by  US  adults:    1997-­‐2002   Altern  Ther  Health  Med  2005  Jan-­‐Feb;  11(1)  42-­‐9   2    McPherson  F  Schwenka  MA,  Use  of  complementary  and  alterna8ve  therapies  among  ac8ve  duty   soldiers,  military  re8rees,  and  family  members  at  a  military  hospital  Mil  Med  2004  May;169(5):354-­‐7   3    Sherman,  et  al,  Complementary  and  alterna8ve  medical  therapies  for  chronic  low  back  pain:    What   treatments  are  pa8ents  willing  to  try?    BMC  Complementary  and  AlternaFve  Medicine  2004,  4:9   4  Goertz  et  al  Military  Report  More  Complementary  and  Alterna8ve  Medicine  Use  Than  Civilians  J   Altern  Complement  Med  2013  Jan  16  [Epub  ahead  of  print]  COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  24. 24. Select SLIDE MASTER to Insert Briefing Title Here Growth of CAM Studies from 1966 to 2009 60000 Pub Med Citations Under "Alternative, Complementary or Integrative * Pubmed Citations Under Alternative Medicine 53371 ** Pubmed Citations Under "Alternative, Complementary or Integrative Medicine" 50000 44813 40000 37538 34014 30000 22875 17237 21695 Medicine" 20000 6559 12543 7006 8739 9888 15083 6989 8671 9769 11538 3441 10000 1 1 0 7 14 50 66-69 162 70-74 312 989 75-79 2476 80-84 85-89 Integrative 90-94 Year Range 95-99 Complementary 00-04 05-09 Alternative Data derived from PubMed http://www.ncbi.nlm.nih.gov/pubmedCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  25. 25. Select SLIDEed  Cita6ons  by  Publica6on  Type     Pub  M MASTER to Insert Briefing Title Here 2009   Evalua8on  Studies  (887)   LeTers  (946)   13%   20%   Case  Reports  (1,471)   13%   Compara8ve  (2,611)   7%   RCT  (2,682)   23%   5%   Clinical  Trials  (4,054)   4%   Other  includes  30+  categories   15%   Reviews  (4,657)   Others  (2,935)   Data derived from PubMed http://www.ncbi.nlm.nih.gov/pubmedCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  26. 26. Select SLIDE MASTER to Insert Briefing Title Here Public’s Concerns With Conventional Medicine• Medical Health Costs• Safety and Iatrogenic Complications• Aging and chronic illness• Technology and knowledge (depersonalization)• Role of science in medicine Picture/clip art is non-copyrighted material taken off the internetCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  27. 27. Select SLIDE MASTER to Insert Briefing Title HereDepersonaliza8on  Picture/clip art is non-copyrighted material taken off the internet COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  28. 28. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Picture/clip art is non-copyrighted material taken off the internet Apr-9-13
  29. 29. Select SLIDE MASTER to Insert Briefing Title Here Picture/clip art is non-copyrighted material taken off the internetCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  30. 30. Select SLIDE MASTER to Insert Briefing Title Here Unique Aspects of Military and IM •  Lifestyle of being a Soldier •  The “testosterone” effect •  Demands of the job •  Leads to a culture of health promotion •  Universal health care •  More flexibility toward available services •  Visibility1 Baldwin CM, Long K, Kroesen K, Brooks AJ, Bell IR, Arch Intern Med. 2002 Aug 12-26;162(15):1697-7042 McPherson F Schwenka MA, Use of complementary and alternative therapies among active dutysoldiers, military retirees, and family members at a military hospital Mil Med 2004 May;169(5):354-7 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  31. 31. Select SLIDE MASTER to Insert Briefing Title Here Psychiatric Drug use among military children on the rise! US Navy Seals blog 2011 Two Army Families deal with PTSD, and Suicide ABC World News 2010 Mild TBI Remains Little Understood and Hard to Mild TBI Remains Little Understood and Hard to Diagnose TBI Remains Little Understood and US Medicineto Mild Hard 2012 Diagnose TBI Remains Little Understood and US Medicineto Mild Hard 2012 Diagnose TBI Remains Little Understood and US Medicineto Mild Hard 2012 Diagnose TBI Remains Little Understood and US Medicineto Mild Hard 2012 Diagnose TBI Remains Little Understood and US Medicineto Mild Hard 2012 Diagnose TBI Remains Little Understood and US Medicineto Mild Hard 2012 Diagnose US Medicine 2012 Diagnose US Medicine 2012 Senators raise concerns with prescription-drug use in military Virginian -Pilot 2008 Army Responds to Rising Suicide Rates www.army.mil 2008COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  32. 32. Select SLIDE MASTER to Insert Briefing Title Here A Return to the Basics Picture/clip art is non-copyrighted material taken off the internetCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  33. 33. Select SLIDE MASTER to Insert Briefing Title Here Empower   Energize  Picture/clip art is non-copyrighted material taken off the internet Enrich   COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  34. 34. Select SLIDE MASTER to Insert Briefing Title Here April 19, 2011 US aims at its deadliest drug problem: painkillersCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  35. 35. Select SLIDE MASTER to Insert Briefing Title Here Concern for Abuse Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007. Department of Health and Human Services, et al.[6]COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  36. 36. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  37. 37. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  38. 38. Select SLIDE MASTER to Insert Briefing Title Here Concerns Among PCMs Top concerns among primary care physicians -- related to controlled substance prescribing. From Bhamb B, et al.[5]COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  39. 39. Select SLIDE MASTER to Insert Briefing Title Here Poisoning Deaths, 1999 – 2006COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  40. 40. Select SLIDE MASTER to Insert Briefing Title Here Poisoning Deaths, 1999 – 2006COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  41. 41. Select SLIDE MASTER to Insert Briefing Title Here Overview•  One of most frequent reasons for physician care•  Over 50 million Americans suffer with chronic pain•  Annual cost ~ $100 billion –  Health care expenses –  Lost income –  Lost Productivity•  Back pain – leading cause of disability for Americans < 45 y/ oCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  42. 42. Select SLIDE MASTER to Insert Briefing Title Here 2011 1980 1984 2005COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  43. 43. Select SLIDE MASTER to Insert Briefing Title Here Military RelevanceCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  44. 44. Select SLIDE MASTER to Insert Briefing Title Here Musculoskeletal Injuries Total  MSK  disabili8es  of  veterans  who  served  from  2001  –  2010:   386, 562 100% Limited motion, 58, 642 15.2% ankle Tenosynovitis 65, 364 16.9% Limited flexion of 74, 627 19.3% leg Degenerative 77, 420 20.0% arthritis, spine Lumbosacral or 110, 509 28.6% cervical strainCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  45. 45. Select SLIDE MASTER to Insert Briefing Title Here Integrative Medicine in the Military Systems Picture/clip art is non-copyrighted material taken off the internetCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  46. 46. Select SLIDE MASTER Integrative Medicine The Center for to Insert Briefing Title Here ~A Department of Defense First~ •  Established Nov 2003 at The Center for Integrative Medicine ~ A Department of Defense First~ •  Began with acupuncture and chiropractic services. Currently offering holistic approach to pain with “Conventional” and “Alternative” modalities •  New facility constructed Dec 2008 on Ft Bliss- name changed to the Interdisciplinary Pain Management Center (IPMC) in 2012 •  The Center has brought in over $800,000 research dollars and had the first senior Samueli InstituteConceptual Plan for an Institute for Integrative Health research associate in the DoD (2004)and Healing. The current WBAMC Interdisciplinary PainManagement Center (IPMC) Campus buildings are on Ft •  The Center conducted the first Military ChiropracticBliss, Buildings 2485D and 2487 study for Acute Low Back Pain in the United States with Samueli Institute and Palmer College of Chiropractic. Approved for publication in Spine As a result of the study, Congress mandated a follow up study with $7.2M funding. •  The Center provides valuable complementary modalities for difficult medical conditions. •  Built and sustained on passion, compassion and “out of the box” ideologyCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  47. 47. Select SLIDE MASTER to Insert Briefing Title Here Integrative Medicine Model The mission of the Integrative Medicine Model is to provide an environment that promotes existing and new medical treatments that may offer safe and effective approaches to the health and healing care through education, clinical practices and research. Additionally, the mission is to implement those modalities that meet research standards into the current standards of patient health care through collaborative partnerships with existing medical practices.COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  48. 48. Select SLIDE MASTER to Insert Briefing Title Here ARMY SURGEON GENERAL ANNOUNCES RECOMMENDATIONS OF PAIN MANAGEMENT TASK FORCE AND RELEASES REPORT June 23, 2010 •  Lt. Gen. Eric B. Schoomaker, Former Army Surgeon General and Commander, U.S. Army Medical Command, said that “this report is a pivotal effort to better understand and treat the growing challenges of providing comprehensive pain management for our patients. •  Recommendations for a MEDCOM comprehensive pain management strategy that was holistic, multidisciplinary, and multimodal in its approach, utilizes state of the art/ science modalities and technologies, and provides optimal quality of life for Soldiers and other patients with acute and chronic pain •  Focus on a holistic, patient-centered approach which employs all modes of therapy--from more conventional means which rely upon the use of drugs, to complementary and alternative modes such as acupuncture, meditation, biofeedback, yoga and others http://ausar-web01.inetu.net/publications/ausanews/ specialreports/2011/06/Pages/ AAPMhonorsfiveArmymedicalofficers.aspxCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  49. 49. TSG Select TF Recommendations for CAMHere Pain Pain SLIDE MASTER to Insert Briefing Title for Management •  Recommendation 4.2.1.1 Adopt a tiered approach for the effective integration of integrative modalities to augment pain management for military and Veteran populations. •  Recommendation 4.2.1.2 Establish integrative pain medicine capabilities at RPCoEs and DoD sites (Army, Navy, and Air Force) to champion integrative pain care with a focus on the best clinical practices, education, and research. •  Recommendation 4.2.1.3 Establish baseline data on the clinical integrative practices being used, along with provider and patient perspectives, through a comprehensive DoD survey, utilizing existing survey models (if appropriate). •  Recommendation 4.2.1.4 Develop an advisory board, with scholarly leaders in various integrative medicine fields, to assist in the development of appropriate programs, ensure proper credentialing of providers, and establish necessary guidelines for outcome measures and uniformed quality of care. •  Recommendation 4.2.1.5 Establish standardized and appropriate strategic communication plans on integrative health care methods for pain medicine. •  Recommendation 4.2.1.6 Develop and fund pilot programs across DoD in the delivery of integrative pain. •  Recommendation 4.2.1.7 Request Health Affairs undertake the evaluation of integrative medicine modalities in Tier I for inclusion as covered TRICARE benefits.COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  50. 50. Select SLIDE MASTER to Insert Briefing Title Here Typical Stove Piped Approach Clinic A Clinic Clinic Clinic B C D Requires a Cultural Shift in Healthcare Delivery The IPMC is that shiftCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  51. 51. Select SLIDE MASTER to Insert Briefing Title Here Integrative Modalities Acupuncture Movement-Yoga Warrior Tai Chi Body Based Manipulation Medical Massage Biofeedback Research Spiritual Mind-Body/Mindfulness DoD Survey of IM Mindfulness and PTSD Core values Spousal Needs Assessment Perspective Most Research in IM (VA/DoD) Identity, Meaning and Purpose Environmental Social Soldier and Family Optimal Healing Philosophy Caregiver Support Groups Green Spaces Educational Curriculum Zen Gardens Social, Family and Task Cohesion Labyrinth Medical Management Behavioral Substance Abuse Counseling Primary Care Champions Coping Skills Clinical Pharmacist Functional Mind Wellness Interventional Spine Restoration Procedures Strength Endurance Flexibility Culinary Education Healthy Choice KitchenCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  52. 52. Select SLIDE MASTER to Insert Briefing Title Here Step Care Model of Treatment Interdisciplinary Pain Department IPMC Tertiary Level Interventions Advanced Pain Medicine Diagnostics and Interventions Secondary Level Interventions Rehabilitation Medicine Behavioral Medicine • In processing Patient • Wellness Fusion Acute/Primary Care Management Centered Campus PCM Pain ChampionsMedical Home • Medical/Post Initiative Early Interventions Patient Self Management Community • Outlying Clinics PreventionBased Medical (PCM and Home Specialty) Goal of restoration with function, risk management COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  53. 53. Select SLIDE MASTER to Insert Briefing Title Here Pillars  of  Integra6ve  Health  Model   Clinical Care is Predicated Provider Patient Education on the Self Community Self Self determination actualization Self Self care awareness Research Self Self discipline responsibility Clinical CareCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  54. 54. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  55. 55. Select SLIDE MASTER to Insert Briefing Title Here Proposed IPMC Organizational ChartCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  56. 56. Select SLIDE MASTER to Insert Briefing Title Here IPMC Programs •  Pain Clinic •  Intensive Outpatient Program (IOP) •  Functional Restoration Program •  acute Intensive Outpatient Program (aIOP) •  Addiction based program http://wunderkammer.ki.se/assets/uploads/image/asset/331/large_Bobbin_tandutdragning_med_tr_d.jpgCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  57. 57. Select SLIDE MASTER to Insert Briefing Title Here Interdisciplinary Pain Management Center IPMC Process Map 2013COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  58. 58. Clinic Process Select SLIDE MASTER to Insert Briefing Title Here Chronic Pain Management Referral Review Individual Service Chiefs Low  complexity  case     Medium/High  complexity  case  (CHUP)   Clinical Evaluation IOP with Medical Provider Multi-disciplinary Pain Management Clinic PCM Rehab Behavioral Interventional IM Health Functional RestorationChampion Therapy Pharmacological Patient identified as good Interventional candidates for holistic care Integrative Patient with minimal symptoms requiring only one provider Behavioral Follow-Up Clinical Evaluation with Medical Provider Pain Champion Patient Discharge Return to PCM with treatment plan. Patient tailored care plans ECHO consultation Multi-Disciplinary Weekly Team Meetings prn PCM participation/education Nurse Case ManagementCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  59. 59. Clinic Process Select SLIDE MASTER to Insert Briefing Title Here Intensive Outpatient Program Mul6disciplinary  Pa6ent  Intake  Evalua6on  (MDPIE)   High  risk,  at  risk  pa6ents   Developmental  Stages   Data  Analyst  to   follow   Day 1 outcomes   NCM   obtains   Individual  Assessments Team command   Patient Patient approval  Completed Interview Huddle Discharge/ BH Weekly Question with Return to Duty (30 mins) (30 mins) Team Multi-D with recs. for (90 mins) meeting Meets  IOP   PCM- Criteria   Augmentation Rehab Does  Not   Meet  IOP   (30 mins) Criteria   ECHO Follow-Up, as needed MD (30 mins) IOP Team (Individualized Care Plan) Core MD, Rehab, BH, Pharm, NCM, Education Additional Treatment recs. to IM PCM-Augmentation Team with ECHO follow-up PRNCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  60. 60. Clinic Process Select SLIDE MASTER to Insert Briefing Title Here Acute Intensive Outpatient Program Acute  Mul6disciplinary  Pa6ent  Intake  Evalua6on  (Acute  MDPIE)     Pain  less  than  7  days   No  history  unevaluated  trauma  (ER  or  PCM  level)   No  history  of  fracture   Data  Analyst  to   follow   Day 1 outcomes   Team  Assessment Individualized Care Patient Patient Plan Patient presents to and Team Biweekly treatments Interview Pain Huddleclinic, given with Champion Meets   Milieu environmentappointmenttime for that Team aIOP   Telephonic/Records Criteria   morning, (40 mins) Begin Nurse Case Management F/U paperwork treatments over 3-6 mos in 2 week re-evaluation with pain completed champion (30 mins) Rehab afternoon  Pa6ent   obtains   Continued treatment prn command   approval   Team consists of MD, IM Chiropractor/ Does  Not   providers, Rehab team, Meet   Chiropractor/DO DO aIOP   Long term Goals Criteria   Discharge/ Return to Duty Create management with recs. for team at PCM/Unit levels IM Provider Treatment recs. to PCM- Educational Awareness PCM-Augmentation Augmentation on Pain Management Team or appropriate IPMC serviceCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  61. 61. Select SLIDE MASTER to Insert Briefing Title Here WBAMC IPMC Patient Visits FY12   FY13   FY  12   July   Aug   Sept   Oct   Nov   Dec   Jan   Feb   Mar   Apr   May   June   Jul   Aug   Sept     Oct   FY13  Total   Total  IPMC  Pa6ent  Visits            Total  Since  Jul  12   Acupuncture   36   114   106   256   151   128   176   234   244   933   1189   Anodyne   25   59   87   171   102   22   39   13   13   189   360   Case  Management   8   Chiroprac6c   325   415   252   992   626   704   517   769   692   3308   4300   Clinical  Pharmacy   0   0   0   Clinical  Psychology   0   6   6   12   12   Electrodiagnos6cs  (EDx)   2   6   8   21   8   9   13   47   98   106   Interven6onal  Medicine   145   133   113   391   75   78   101   125   41   420   811   Massage  Therapy   0   0   0   Physical  Therapy   0   3   41   43   45   60   192   192   Primary  Care   94   128   109   331   114   82   110   93   132   531   862   Research   6   13   11   30   16   15   2   6   2   41   71   Yoga   0   9   65   81   120   65   340   340   Total   631   864   684   2179   1117   1143   1078   1424   1310   0   0   0   0   0   0   0   0   6064   8243   COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  62. 62. Select SLIDE MASTER to Insert Briefing Title HereCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Picture/clip art is non-copyrighted material taken off the internet Apr-9-13
  63. 63. Select SLIDE MASTER to Insert Briefing Title Here Chiropractic Care in the MilitaryCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Picture/clip art is non-copyrighted material taken off the internet Apr-9-13
  64. 64. Select SLIDE MASTER to Insert Briefing Title Here Synergy between Integrative and Conventional Medicine Interdisciplinary Health and Pain Healing Management Center Research Endeavors Educational Global Outreach Combat Stress Context Disorder PTSD Facility Community TBI Treatment Facility NICoE Medicine Patient Surgery Centered Primary Care Care Perioperative Patient Centered Prescriptions Medical Home Polypharmacy Behavioral Care Clinical PracticesCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  65. 65. Select SLIDE MASTER to Insert Briefing Title Here Military IM ResearchCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Slide 65 of Apr-9-13
  66. 66. Select SLIDE MASTER to Insert Briefing Title Here ResearchSurvey of Complementary and Alternative Medicine Services within the Department of Defense Acupuncture treatment for sinusitis COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13
  67. 67. Select SLIDE MASTER to Insert Briefing Title Here Survey of Complementary and Alternative Medicine Services within the Department of DefenseCOL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / richard.petri@us.army.mil FOUO Apr-9-13

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