Facility Profile: Casa Palmera
by Joseph Shurman, MD; David Bergman, MD, DLFAPA; George Koob, PhD; Michael Lardon, MD; and Phyllis Meagher, MBA
 Publisher’s note: Casa Palmera, an addiction treatment
facility, has recently added a pain management program based on the “Share The
Risk” program developed by Dr. Joseph Shurman. This program advocates the utilization
of a number of specialists in treating chronic pain. Casa Palmera, for the first time,
brings all of the necessary expertise together in a single facility. We are offering our
readers the opportunity to learn about their program because they have a stated interest
in informing physicians across the country. Without endorsement or recommendation, this
publication offers the information that follows as a service to our readers.
The contemporary Casa Palmera in Del Mar (a small coastal community of San Diego,
California) opened its doors in June 2005. The ninety-five (95) bed residential treatment
center was dedicated to the care of individuals with addictive, eating, and emotionally
traumatic disorders. As time went on it became apparent that another population of
patients, with many shared characteristics and often co-occurring with Casa’s
patients, was vastly under- or mistreated in our community and the nation, namely those
with chronic pain and comorbid medication/drug dependence. It was the commitment to state
of the art treatment for this patient population that led to the creation of Casa
Palmera’s newest clinical program.
“Share the Risk” Model
Dr. Joseph Shurman, MD, nationally recognized specialist in Pain Medicine, first developed
the “Share the Risk” model’s basic principles in January of 2002 in San
Diego, California. Interdisciplinary teams have been shown to improve patient care in a
number of complex clinical situations and also deliver the best possible treatment to this
challenging population. The “Share the Risk” fundamental premise is that no
physician—no matter how well educated, confident, compassionate, committed or
meticulous—can adequately meet all the needs of patients with chronic and intractable
pain and chemical dependency.
Instead, the model calls for an interdisciplinary team approach to treat this special
needs pain patient. Share the Risk was initiated when, in early 2000, physicians
prescribing opioids for pain relief, particularly nonmalignant pain, were being sued for
giving too little, giving too much, or even for “murder.”1,2 Several
publications had made the statement that up to “seventeen percent (17%) of doctors
who treat pain were investigated each year, and that a pain treating physician was
arrested and charged criminally somewhere in the United States every day.”3,4
Although these statements are debated, depending on whom you speak to, the model was
started in response to this problem. At the same time, the program—using multiple
specialists—was extremely beneficial for the patient since it decreased the overall
risks of treatment. The core of the model is elaborated through the five P’s as
follows:
• P1-Professional Pain Management Delivery System
• P2-Patient Advocacy and Education Support
• P3-Paperwork
• P4-Precautions
• P5-Physical Therapy and Integrated Techniques.
Please refer to the May 2009 issue for the complete text. In the event you need to order a back issue, please click here.
— May 2009
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