Montana physicians urge team-based approach to persistent pain, call it a public-health issue

At a physician panel in Missoula, Montana, several clinicians said chronic (persistent) pain should be treated as a public-health problem and urged hospitals and clinics to build interdisciplinary teams that prioritize care coordination and behavioral services over isolated procedures.

Dr. Randall Seacrest, medical director of the Montana Spine and Pain Center in Missoula, said the region is “viewing chronic pain now as a public health issue,” and argued that successful clinics must build systems that extend care into the community. “Pain care boils down to about 90% coordination of care and about 10% expertise,” Seacrest said.

Panelists described common team components: a clinician experienced in chronic pain (physiatry, anesthesia or an interested primary-care doctor), behavioural health specialists, physical and occupational therapy, pharmacy support and nursing. “Physical therapy and movement are such a huge piece of any sort of chronic pain management,” Seacrest said, adding that inconsistent referral patterns and mismatched therapy approaches can worsen outcomes.

Dr. Catherine Borgenich, geriatrician and medical director of Bozeman Deaconess Hospice and Palliative Care, described local work to integrate palliative and pain services into hospital care and emergency-department workflows, and said palliative consult teams can reach patients who lack access to specialized pain clinics. “We have palliative care consultants — a clinical nurse specialist, a social worker and a spiritual counselor — who will see patients in the hospital, in the cancer center, and sometimes in office,” Borgenich said.

Panelists said behavioral health is the most commonly missing piece. “The behavioral piece could look like a lot of different things — psychiatry, psychology, sociology — the more the better,” said Dr. Michael Schaubacher, medical director of the Northern Rockies Regional Pain Center in Billings. Several speakers said programs that lack consistent psychological or addiction services struggle to show long-term improvements in function.

Speakers also emphasized the role of pharmacists and nurses in coordinating care. Seacrest noted the value of embedded pharmacy expertise for medication management. Multiple presenters said nursing staff are “the glue” that holds coordinated care together and recommended that hospitals recognize and fund nursing time devoted to coordination, patient education and follow-up.

The panelists urged creation or wider use of clinics that combine consultation, education for local providers, outreach clinics or telemedicine and data collection for research. Seacrest and others said that system-level investments—protocols, referral pathways and funded care coordination—make more difference for population health than isolated interventions.

The panel closed with agreement that treatment decisions require both clinical judgment and better evidence but that care cannot wait until “gold-standard” trials are complete; clinicians urged pragmatic programs that combine care coordination, movement therapies and behavioral supports while researchers build more robust long-term outcome data.

Less-critical details mentioned during the discussion included local program names and pilot efforts at Saint Pat’s (Missoula), Bozeman Deaconess and regional pain centers in Billings and Kalispell.