Improving functional outcomes and lowering health care costs by enhanced integration of primary care providers and pain medicine physicians for the management of chronic non-cancer pain patients

The goal of this program is to demonstrate that medical care of the chronic non-cancer pain patient (e.g. low back pain) by the Primary Care Provider (PCP), after initial consultation with the Pain Medicine Specialist (PMS), will enhance patient pain functional outcomes, improve health related quality of life and optimize utilization of the healthcare system. Using a prospective, randomized clinical trial design for patients with chronic non-structural non-specific low back pain will:

1. Demonstrate that functional improvement measures over a 6-month period for chronic low back patients under the care of PCP, using a therapeutic plan formulated initially by the PMS, are equivalent to those under the care of the PMS only.
2. Show that patients randomized to the PCP group will have fewer pharmacological interactions (e.g. anti-fungal medications with opioids) because the PCP can monitor and optimize the necessary ancillary treatment measures (including hormonal effects of opioids).
3. Patients will have higher satisfaction scores in the PCP group than in the PMS group due to their greater familiarity with the PCP, possibly more total encounter time with the PCP, and generally shorter and more convenient travel. 
4. Demonstrate that PCP treatment will reduce healthcare costs by minimizing the time patients spend with specialists (in this case, PMS) while allowing greater access of chronic pain patients to the expertise of a PMS.