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(298) Pain education in primary care and rehab services improves patient outcomes

      A better understanding of pain results in an improvement in pain and function, decrease in pain catastrophizing, and a decrease in utilization of unnecessary services. Pain care should include easy access to basic pain education in primary care and rehabilitation services. We trained physicians and medical home teams across 40 clinics at Providence Oregon Medical Group (PMG) in pain neurophysiology and evidence-based pain care in 2 hour sessions. Skill-building was encouraged through training in a case review process, attended by all medical home team members. All 300 rehabilitation staff members were trained in basic pain care during two live trainings over 2 years. An advanced 16-hour training was conducted for specialty therapists. Online case reviews were conducted monthly. Pain education for patients included videos shown in treatment rooms, written materials, and a 2-hour pain class. Patients self-selected into the following pain education categories: no class, class + specialty persistent pain rehab, class + behavioral health (not specific to pain), or class + rehab + behavioral health. Patients were given the pain catastrophizing scale (PCS), pain disability index and a 7-question pain comprehension quiz, before and after intervention. Changes in the PCS were compared using t-tests or Wilcoxon matched-pairs signed rank tests. Overall, class attendees had a significant decrease on PCS (p<0.001), while those who did not attend class had no change in PCS. Sub-group analysis showed that class + rehab resulted in a significant decrease on PCS (p<0.01). We further noted trends towards a decrease in ED usage, opiate prescribing, and annual case cost among clinics who participated in the program. In conclusion, our program facilitated greater patient engagement in a plan of care, significant decreases in pain-related anxiety and a trend towards reduction in utilization of unnecessary services.