Primary care physicians often treat patients with chronic pain -- and often find themselves caught between their discomfort with prescribing potentially addictive narcotics and the practical difficulties of finding timely access to a pain clinic.

The Duke Pain Clinic has customized a new strategy for dealing with the complexities of narcotic-based pain management -- which also creates a more open line of communication between the patient, the patient’s doctor, and the pain specialist.

Most patients who visit the Duke Pain Clinic aren’t prescribed narcotics, says Jennifer Asbell, nurse manager at the clinic. But for those who do need pain medication, a special system called a trilateral agreement has been established.

In this agreement, the patient, the pain physician, and the patient’s primary care physician all agree on a care plan in which the Pain Clinic works with the patient to stabilize the pain, and then the primary care doctor takes over maintenance. This agreement is an actual document, which the patient gets from the Pain Clinic and must have signed within 90 days by his or her primary care physician.

If the primary care doctor ever feels uncomfortable about the patient’s progress (or lack thereof), he or she can send the patient back to the Duke Pain Clinic at any time for an evaluation and intervention if necessary.

So far the results have been heartening, says Asbell. “We’ve established trilateral agreements with more than 20 physicians since we began the practice in July 2009,” and community physicians report that this more-formalized arrangement makes them feel better about prescribing these strong drugs to patients long-term, she says.

The trilateral agreement was initiated as part of an overall overhaul of the Pain Clinic’s systems, which has cleared a path for easier patient access. “We now offer appointments within seven to 10 days,” says Asbell. “It’s made a huge difference in our being able to see new patients in a timely fashion.”

Duke Pain Clinic Appointments

The Duke Pain Clinic is now offering appointments within seven to 10 days.

Physicians can call 919-684-PAIN (919-684-7246) for more information about referring a patient for an initial consult.