Evaluation of a Pharmacist Managed Telephone Pain Clinic for Neuropathy Treatment.

Pain is prevalent in our society, affecting more than a quarter-million U.S. adults and leading to poor patient outcomes. At the Veteran's Affairs San Diego Healthcare System (VASDHS), a Telephone Pain Clinic (TPC) was developed to improve these outcomes. The purpose of this study was to evaluate the effectiveness of TPC in improving neuropathic pain. A retrospective cohort study was conducted at the VASDHS comparing pre- and post- self-rated Numeric Rating Scale (NRS-11), an 11-point scale from 0 to 10 with 0 equaling no pain and 10 equaling most severe pain. Patients were included if they were referred and enrolled to the TPC for neuropathic pain. They were excluded if they were co-managed by another pain provider or were referred for any other pain conditions. A total of 830 TPC patients were screened between January 2008 to December 2009 and 52 patients met criteria. Patients who participated in the clinic were found to have a significant 0.83 (p = 0.014) reduction in mean pain score from baseline (6.62, SD 1.96) to discharge (5.79, SD 2.49). At discharge, pain medications that were increased were use of serotonin and norepinephrine reuptake inhibitors (SNRIs), pregabalin, and capsaicin. Management by the TPC showed promise and trends toward reducing pain experienced by patients with diabetic neuropathy, fibromyalgia, or postherpetic neuralgia. The TPC also may be more effective in maximizing evidenced-based pharmacotherapy for neuropathic pain, suggesting expertise by pharmacist clinical specialists.