Team Approach Improves Chronic Pain Care in Oklahoma Clinic


Providing chronic pain patients with seamless access to non-pharmacological therapies and self-care skills requires clinics to re-think business as usual. Dr. Vinny Francio, DC, MS, practices Integrative Spine Care and Integrative Pain Management for Essential Integrative Health in Oklahoma City, an integrative spine and pain management clinic, in collaboration with orthopedic spine surgeon and integrative physician Dr. Art Conley, MD.

Improving chronic pain care for his patients is especially important to Dr. Francio because the state of Oklahoma is one of the leading states in prescription drug overuse with nearly 800 deaths per year due to drug overdose according to the Center for Disease Control.

Earlier this month, Dr. Francio shared his story in a Virtual Congress as part of Samueli Institute’s Chronic Pain Breakthrough Collaborative.

“Our patients were tired of traditional pain management,” said Dr. Francio, whose team created a model of care that better serves his patients. This effort was part of Essential Integrative Health’s participation in the Chronic Pain Breakthrough Collaborative, a systematic approach to health care quality improvement.

Assessment Looks at the Bigger Picture of Chronic Pain

The first step of the chronic pain care model is an integrative treatment intake. The new intake includes a physical assessment, a medical assessment, a behavioral assessment and nutritional assessment.

“By the end of the treatment assessment, we sit down with the patient and explain our entire treatment protocol, including medication management strategies, physical medicine strategies, behavior, and nutrition,” said Dr. Francio.


Integrating the multidisciplinary assessments in a single visit helps to minimize patient burden and optimize reimbursement, in addition to facilitate the patient’s transition from a traditional pain management program to an integrative model.

“At the same time patients see us for medical treatment; they also get an adjunctive assessment with one of our other pillars—physical medicine, behavior, or nutritional medicine.” -Dr. Francio.

By developing this integrative assessment and making time for a weekly meeting to collaborate on administration and clinical needs, Dr. Francio found that his team was able to maximize their current resources to provide better chronic pain care to patients in the Oklahoma City and surrounding metro area.

Teamwork Benefits Patients and Providers

An integrative pain practitioner for over 20 years, Heather Tick MA, MD, believes that working in teams is important for both the patients and the providers.

“Patients with pain complaints are some of our most frequent and our most challenging patients. They’re very difficult in terms of the complexity that they present when it’s chronic pain, and this applies to every single specialty. So, when we feel inadequately prepared to deal with the complexity, and unsupported in the work, that adds to physician stress. Working in teams is a chance to mitigate the situation.” –Dr. Heather Tick



Dr. Tick guides discussion at the Chronic Pain Breakthrough Collaborative Learning Session

“Patients want seamless care,” said Dr. Tick. “They want to know that their team members speak to each other and collaborate, so that even when there are times when there are different team members who want to approach a problem differently, patients are fine with that as long as they know that there’s dialogue and that their wellbeing is at the center of the conversation.”

Dr. Tick serves as an integrative pain care subject matter expert as part of the Chronic Pain Breakthrough Collaborative faculty. Faculty guided participants through the components of team-based chronic pain care:

  • creating and strengthening interdisciplinary pain management teams;
  • promoting an understanding of self-care and non-pharmacologic treatment options, and
  • developing shared intake assessments and care planning processes that include the patient as an expert in their own care.

Dr. Mittman, Chronic Pain Breakthrough Collaborative learning session

Like Dr. Francio, Paul Mittman, ND, of the Southwest College of Naturopathic Medicine Medical Center found that participating in the Chronic Pain Breakthrough Collaborative helped his team to become more integrated in their approach to care.

We took three people from very different backgrounds—an acupuncturist, a medical doctor and a naturopathic doctor and through this process really started to unite as a team,” said Dr. Mittman.

This increased integration of interdisciplinary care providers is part of the solution to decrease the number of patients relying solely on opioids for chronic pain. When providers are connected in meaningful ways to each other around patient care, it leads to more choices of disciplines and strategies available for the benefit of the patient.