Last month we introduced you to our latest Paradigm Hero, Butch Coffman. His story began when he slipped on the ice going to work one winter morning. Over the next 12 years, his condition worsened and he developed chronic pain.

“It took everything I had away from me,” said Butch.

Thankfully, he was eventually introduced to the Paradigm Outcomes care management team and his nurse case manager Kathy Metcalfe, RN, CCM, CDMS, PSPM. Today we speak with Kathy to learn more about the challenges of Butch’s chronic pain case and what it took to turn his life around and achieve the best possible recovery.

Obviously Butch was in severe pain when you met him, but what made his case especially complex and his recovery so remarkable?

Butch was 61 years old at the time I met him and his injury had occurred many years prior. He didn’t want to talk to me, but his wife answered all my questions and told me he spent most of each day lying in bed. She said he couldn’t even walk within their home without a walker. When Butch did speak, he said he wouldn’t be able to live without his pain medication and spinal cord stimulator.

In addition to this initial resistance, Butch lives in a somewhat rural part of Michigan where healthcare options are limited. His treating provider was an interventional anesthesiologist whom we had to work with as there were no conservative pain management providers in the area and Butch liked him. This provider simply refilled pain medications every month. When I asked for orders to create a multi-disciplinary team the physician said it couldn’t be done. Butch had also been seeing a psychiatrist for several years. She prescribed multiple medications for depression and anxiety and enabled Butch to continue the sick role.

What did you do to assist Butch and his family?

First, I established rapport with his wife who was a retired nurse. I explained the complications from chronic opioid use and gained her support moving toward change. I assured her that Paradigm wouldn’t do anything to or for her husband without his agreement.

Using motivational interviewing at the first few provider appointments, I learned Butch missed being able to fish and shoot a black powder rifle competitively. Together we agreed these activities should be part of his desired outcomes.

With these goals and others in mind, the team proposed a treatment plan that included counseling and aqua therapy to aid him in coping with his pain. I gained Butch’s approval to discuss this plan with his provider. Once we identified the necessary care providers, Butch agreed to travel up to an hour each way for his appointments. I earned Butch’s trust as the therapies improved his chronic pain condition and general health and outlook.

How did Paradigm’s team approach benefit him?

Once Butch trusted me, Dr. Moinzadeh, the Paradigm Medical Director on the case, provided a safe weaning schedule for all his medications. Butch’s doctor continued writing the same orders for pain medication and simply left it up to Butch how much to take. Butch worked with me to follow the very slow taper planned for his pain medication. At Dr. Moinzadeh’s suggestion, Butch tried turning off his spinal cord stimulator for an hour after aqua therapy and gradually increased the time it was off. As his strength improved, Butch came to see the spinal cord stimulator was of no benefit and asked to have his it removed.

Dr. Moinzadeh also gave input on the multiple medications the psychiatrist was prescribing. I coached Butch in how to discuss medication reduction with his psychiatrist. This enabled him to become his own advocate.

So you’re focused on Butch’s long-term wellness?

Absolutely. I helped him develop self-management strategies for his pain and set goals that we discussed weekly. Once the cognitive deficits from the medications were eliminated, Butch regained his confidence and returned to the activities he enjoyed before his accident: fishing and black powder shooting.

It takes time to develop a relationship with a person who has lived with chronic pain a long time. Who they were before the injury got buried beneath the depression, the changed family relationships, the cognitive fog of medications and the loss of livelihood. Paradigm’s nurse case managers are trained in techniques that guide the injured worker to better health and functional recovery.

To learn more about Paradigm Outcomes and how our Network Managers support Heroes like Butch Coffman, visit our website or join the conversation on LinkedIn, Facebook, Twitter, or YouTube.

About the Network Manager

I went to nursing school when I was in my 30s. After six years working in the emergency room, I began a career in case management. When I lived in Florida, back in 2004, I worked for Betty Reid and was dedicated to Paradigm cases. I returned to Michigan in 2007 and Paradigm hired me to join the pain team in 2011.

I have lived in El Paso, Texas, Carmel, Indiana and St. Petersburg, Florida. Two years ago, I bought a house on a lake, and my first boat, in mid-Michigan. The best part about living on a lake is watching my four granddaughters grow up playing here. I volunteer at our community theater as assistant to the prop master, making and managing props for the shows. I am an avid reader. Although I will reach retirement age next year, working for Paradigm Outcomes is too enriching to leave.