Chronic Pain: A Case Application of a Novel Framework to Guide Interprofessional Assessment and Intervention in Primary Care.

Background: Chronic pain is a complex condition that poses challenges in assessment and treatment. Primary care teams, especially in rural areas, may have a role in managing this population, providing interprofessional care to optimize patient outcomes. Tools are needed to aid these clinicians in assessing chronic pain. Aims: The aim of this article is to present the case application of a clinical reasoning framework proposed by Walton and Elliott, which is used to identify drivers of chronic pain in a 61-year-old male patient with a remote history of spinal injury. Furthermore, it aims to demonstrate that an interprofessional, individualized intervention strategy can improve patient outcomes. Methods: This case took place in a multidisciplinary primary care team in rural northern Ontario, Canada. An assessment was completed by the author, including collection of the patient's history, a medication review, and the use of multiple validated patient-reported outcome measures (PROMs), all of which were used in applying the framework. Results: Three relevant drivers of his pain experience were identified: central nociplastic, cognitive/belief, and emotional/affective. A pharmacist and social worker then used multimodal interventions to address these drivers, which yielded improvements in scores on multiple validated pain measures but also improved the patient's self-reported quality of life. Conclusions: A clinical reasoning framework can provide a basis for identifying drivers of chronic pain during assessment and guide primary care clinicians to targeted interventions. Broader applications of this framework by primary care providers could serve to increase capacity for managing chronic pain in Canada.