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Treatment of Chronic Pain in a Free Clinic Setting


Jill Cottel, MD


Caring for patients with chronic pain in a free clinic setting presents its own unique set of challenges.  Patients often wait until later in the presentation of their illness to seek care.  Obstacles to care can include language barriers, literacy and educational issues, and lack of consistency with health care services.  Medication options can be limited due to cost and availability, and patient compliance with the available medications is variable.  Patients have limited financial resources and struggle with basic needs such as food, clothing, transportation and housing.  Many patients have had traumatic life events, and therefore are dealing with emotional and mental health issues as well.  

Low dose naltrexone (LDN) has consistently been demonstrated to be helpful in the treatment of chronic pain from a wide variety of causes.  Despite the high prevalence of chronic pain in free clinic patients, the use of LDN has not been common due to issues with cost, availability, and lack of familiarity with the treatment.  In this presentation we look at a case series of patients receiving care at a free clinic in the Commonwealth of Virginia, who have been prescribed LDN for chronic pain.  

Session Learning Objective

--Describe the barriers to care that face the typical patient presenting for treatment in a free clinic.

--Describe the burden of chronic pain disorders on a national and worldwide scale, both in terms of effects on individual health and for socioeconomic effects on a population basis.

--Describe mechanisms of action of LDN in regards to the treatment of chronic pain.

--Identify patients who are candidates for LDN and learn how to appropriately prescribe it.

Session Outline

--Discussion of the scope of the problem of barriers to care for patients being treated in free clinics.

--Discussion of the burden of chronic pain disorders and the implications for population health.

--Brief review of the mechanisms of action of LDN in regards to the treatment of chronic pain.

--Case presentations of patients who have been treated with LDN for chronic pain in a free clinic setting.