Telementoring has the potential to allow physicians to better care for patients in medically underserved, remote areas. One of the primary use-cases for telementoring is in pain medicine, and specifically its connection with managing the prescription of opioids. There are distinct opportunities for telementoring to improve this area of medicine, according to a recent commentary in Pain Medicine.

The focus of the commentary is the Project ECHO (Extension for Community Healthcare Outcomes) initiative. The project, which began in New Mexico in 2003, uses videoconferencing to connect remote physicians to specialists who provide mentorship and insight into specific disease states. This peer-to-peer approach allows physicians to receive training on a wide variety of conditions, which could translate to better-quality care for patients. Project ECHO hopes to reduce health disparities by distributing specialist knowledge and training to physicians in all areas, especially underserved rural areas.

This is crucial for managing clinical activities such as the prescription of opioids, as patients in rural areas are much more likely to be prescribed opioids for pain than those in urban areas. A total of 2 reports from the last decade cited the crisis in America in pain management and substance use disorder. They also called for accessible education for physicians. A tool like Project ECHO is a possible solution, offering clinician education on pain management that might educate physicians on alternative pharmacological or nonpharmacological treatment options for pain.

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To date, there have been 48 peer-reviewed publications exploring the effect of Project ECHO on pain and opioid management. Of these, 11 articles showed practice change, and 6 showed improved patient outcomes. Although there are challenges to implementing the program including physicians’ limited time and the fact that the model does not support randomized controlled trials, Project ECHO is still an excellent resource for physicians. Recently, the program was implemented to train firefighters, paramedics, and law enforcement officers in opioid and pain management, and resulted in plans to cover areas such as compassion fatigue and self-care in first responders. On the basis of the success of previous endeavors in pain management, Project ECHO is also expanding to other specialties, hoping to bring improved care to underserved areas around the globe.


Katzman JG. ECHO Telementoring for pain, palliative care, and opioid management: progress, challenges, and future goals. Pain Med. 2020;21(2):220-225.