My name is David Paris, D.C. and I have been in clinical practice for the Veterans Administration (VA) currently working at an outpatient clinic in Redding, CA for approximately 7 years. Prior to that, I was in clinical practice since graduating from Palmer College of Chiropractic West in 2001. Please accept this essay as not only my scholarship application but also as an “update from the field” from someone who’s career, clinical skills and hopefully patients have benefitted from attending PAINWeek conferences the last two years and will again this year.

Many are surprised to hear the words “chiropractor” and “VA” in the same breath and some more surprised to hear about our focus on pain management here. Since approximately ‘04/’05 the VA has had a D.C. or D.C.’s on staff in every VISN (large service areas that divide up the nation) that services veterans in the US. I’ve been fortunate enough to be one of those chiropractors. I have also been fortunate to also be involved in other pain related areas and able to assist in expanding our pain service offerings here. I hate to use the word “I” here as truly nothing has been achieved on my own and our pain team shares in any stated successes or improved programmatic developments.

In the beginning my sole role here was clinical care, doing consults and providing conservative musculoskeletal care for a range of conditions. Our typical patient is a senior male, all are veterans but there is a rising trend of younger soldiers coming into the VA from our more recent conflicts and more woman veterans it seems. My clinical role expanded when I was asked to sit on our local “pain committee,” which is our multidisciplinary group that provides support, assistance and clinical recommendations to other providers with difficult pain cases. Immediately, I realized that not only did I need further education to enhance my own pain management skills and knowledge, but also that our rural clinic was limited in both resources and access to not only clinical services but education and training within those services. Some barriers due to access for shared training, some due to logistics, and some due to a relative lack of one area/location/event to get across the board training in pain.

The vast majority of the patients I see here present with musculoskeletal pain complaints and a high percentage present with significant co-morbidities, post-traumatic stress disorder and traumatic brain injury being more prevalent recently. Many are also on escalating opioid doses and finding alternatives and/or co-management strategies was difficult. After some time dealing mainly with opioid issues our local pain committee realized the major barriers we faced were ones of access to the full spectrum of pain services. We tasked ourselves to think of ways to provide those services more easily and readily and also to come up with services we might add to our existing clinical services.

This is where PAINWeek came in. I discovered through a web search and came across the American Society of Pain Educators. I was very interested in their Certified Pain Educator program, personally, but more importantly became aware of the conference and believed it could serve our immediate needs. We organized a few on the local pain committee to attend in 2010 and we were impressed at how each of us with differing backgrounds and educational needs came away fulfilled. We immediately came back to work recharged, enthused and determined to grow our pain offerings here, and we have. Our pharmacy began a thorough medication screening process and assisting in opioid conversions, something I still work at and am looking forward to learning more about. I brought back the pocket pain manuals and offered them to every provider on the pain committee. We shared and utilized so much information it’s difficult to state it all. I began the process of organizing a local Cognitive Behavioral Program (CBT) and I’m happy to say much of the initial information and inspiration was achieved at PAINWeek. That multidisciplinary team-taught program is now in its second year and receives continued referrals from providers here where it has been well received. I plan to have constant evolution and improvement in that program from attendance at PAINWeek. Future plans are already in place to have multidisciplinary stand- alone classes for veterans regarding nutrition, spinal care/conditions, medications, addiction etc. all related to pain. I believe the pain committee itself gets better every year as we bring back current knowledge and understanding to share with not just the pain committee but all of the physicians/providers here.

Regardless of the challenges working in a relatively rural clinic presents we have the advantage of a closeness amongst clinical staff that perhaps large medical centers do not share. We have staff meetings where all of the staff can be in one room and continuing education events where we all sit side by side. “Curbside” consults are the norm and I believe this has made our ability to pass along the “clinical pearls” we gain from PAINWeek even more useful and important for us. We are also blessed as a team with an administrative staff that willingly creates openings as opposed to obstacles and supports, encourages our growth in every way.

Attending PAINWeek 2012 will enhance not only my management and knowledge of conservative care clinically as we continue to move forward with knowledge of current research but also new techniques and therapies for rehabilitation. I’m especially looking forward to attending more “hands on” workshops this year as my first two years were spent with a focus on pain educators forum classes. I was happy to see some growth of the physical medicine classes and some moved to earlier in the week this year. I find the attendees to all be focused on one goal, improved care for pain patients, without regard to degree or profession. I find that the variety of classes allows me to grow within my own specialty, but also, maybe more importantly, allows me to learn and gain knowledge and understanding of areas I have previously been unfamiliar with. As a provider who considers myself a willing “lifelong learner” I look forward to attending, networking, learning and growing personally and professionally. In a nutshell, I simply find it inspiring.

My future goals are to hopefully affect positive change as much as I can in regards to pain care not just here at my facility and the VA but in my community and amongst my colleagues. My hope is to eventually bridge the gap of creating change with some research to solidify our knowledge and acceptance of that change. To that end, I have recently been invited to attend a collaborative research meeting as a partnership between the VA and UC Davis. My application of initial ideas was focused on pain research and mining the vast amount of data on our computerized patient record system to gain insight into our pain patients, our current efforts, trends and potential future directions we might take. I know full well attending PAINWeek will assist in improving that effort. Being involved in research is a long-term career goal I’m looking forward to achieving it someday.

Thank you for your consideration. I think I can speak for the pain team here when I say that we truly appreciate the ability to attend and is something that is penciled in early on our calendars. You are providing one of the only venues of this kind and it’s sorely needed.