Pain Prevention in Integrated Primary Care

Pain is a highly common and impactful condition for which integrated primary care (IPC) clinics can play a significant role in prevention. This chapter will provide a definition of pain, including acute and chronic pain, and review national statistics on its prevalence. Biopsychosocial risk factors for developing chronic pain are reviewed, and screening measures appropriate for the IPC setting are described that can assist with routine identification of chronic pain and its functional impact. For high prevalence conditions, such as back pain, additional measures can be used to assist with risk stratification. Tertiary pain prevention, in which chronic pain is treated through educational or psychological interventions, has received the most attention to date in IPC research and practice. In contrast, there is little description of IPC’s role in both primary prevention (e.g., reducing illness and injury that leads to pain) and secondary prevention (e.g., reducing the transition from acute to chronic pain). Based on stepped care models that suggest using multiple points of intervention before the onset of chronic pain, key IPC intervention modalities are described. Suggestions for successful implementation of a comprehensive IPC program to address pain prevention are offered.