Institutional members access full text with Ovid®

Share this article on:

The Primary Practice Physician Program for Chronic Pain (© 4PCP): Outcomes of a Primary Physician—Pain Specialist Collaboration for Community-based Training and Support

Chelimsky, Thomas C. MD*; Fischer, Robert L. PhD; Levin, Jennifer B. PhD; Cheren, Mark I. EdD§; Marsh, Sybil K. MD; Janata, Jeffrey W. PhD

doi: 10.1097/AJP.0b013e3182851584
Original Articles

Objectives: One in 3 patients sees a primary care physician (PCP) for chronic pain yet most PCPs receive no training in this field. We evaluated the impact of 4PCP (© Primary Practice Physician Program for Chronic Pain) comprising of a specialist-PCP training collaboration integrated with clinical support.

Methods: This prospective, controlled pilot study randomly assigned 31 physicians to receive a training program either immediately or after a 1-year control period. 4PCP includes: (1) an active learning arm, providing patient-focused, practice-based learning collaboration emphasizing the biopsychosocial pain model; (2) a PCP-led clinical support arm facilitating rehabilitative matrix style care by teams of pain-informed health providers. Main outcome measures included a 19-item chronic pain physician perspectives questionnaire, physician engagement through continuing medical education hours earned, and an array of established measures of patient pain and function.

Results: PCPs receiving the intervention reported improvements in diagnosing and managing chronic pain (P=0.023), especially its functional consequences (P=0.008), in treatment satisfaction, and in involving other disciplines. Mean visit time dropped from 20 to 11 minutes (P<0.03) with improved patient outcomes, which correlated with 4PCP physician engagement. Significant benefit began at 10 continuing medical education hours and proved durable 1 year after trial.

Discussion: This pilot study demonstrates successful interdisciplinary chronic pain management by PCPs with durability of training effect, improved patient outcomes, visit efficiency, and job satisfaction. 4PCP provides a promising framework to propel the national concept of PCP-specialist collaboration for chronic pain management.

Supplemental Digital Content is available in the text.

*Department of Neurology, Medical College of Wisconsin, Milwaukee, WI

Mandel School of Applied Social Sciences, CWRU

Department of Psychiatry

Department of Family Medicine, Case Medical Center, Case Western Reserve University School of Medicine and University Hospitals, Cleveland

§Healthcare Improvement Skills Center, Improvement Learning, Shaker Heights, OH

Supported by the Josiah Macy, Jr Foundation, New York, NY. The authors declare no conflict of interest.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Reprints: Thomas C. Chelimsky, MD, Department of Neurology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226 (e-mail:

Received April 4, 2012

Accepted December 27, 2012

© 2013 by Lippincott Williams & Wilkins