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Paul Chelminski, MD, MPH, FACP - UNC-Chapel Hill. Chapel Hill, NC, US

Paul Chelminski, MD, MPH, FACP Paul Chelminski, MD, MPH, FACP

Director and Clinical Professor of Allied Health-PA Program and Clinical Professor of Internal Medicine | UNC-Chapel Hill

Chapel Hill, NC, UNITED STATES

Expert in pain-management with a focus on deprescribing opioids while finding what works best for each individual patient.

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Biography

Dr. Paul Chelminski is a professor of medicine and an experienced educator of medical students and resident physicians at the UNC School of Medicine. Since 2001, Dr. Chelminski has practiced primary care in the UNC Internal Medicine Clinic. This clinic is recognized nationally for the high quality team-based care that it provides to patients with chronic illnesses. He has extensive experience in collaborative practice with physician assistants, clinical pharmacists, and nurse practitioners. In this setting, he has been engaged in inter-professional education and mentorship as well.

Prior to a career in medicine, Dr. Chelminski graduated from Duke University with a degree in Medieval and Renaissance Studies. He then served in the United States Peace Corps in Mali, West Africa. This experience led him to choose medicine as a career.

Returning from the Peace Corps, he completed post-baccalaureate premedical courses at the University of Pennsylvania at night while working a daytime job. He attended medical school at UNC-Chapel Hill and then completed a combined residency in internal medicine and pediatrics at UNC Hospitals.

After residency, Dr. Chelminski worked for two years in rural Siler City, North Carolina, in a primary care practice with family practitioners where he also staffed the emergency department. Dr. Chelminski subsequently completed a primary care fellowship at UNC and received a master’s in public health. At UNC, Dr. Chelminski has been a member of the Academy of Educators. He was one of two inaugural recipients of the Charles Sanders Clinician Scholars Award, which recognizes master medical educators devoted to personalized care. Dr. Chelminski used the award to undertake a home visits curriculum and embed the humanities in clinical teaching.

Dr. Chelminski relishes the opportunity to bring his broad experience in inter-professional practice and education to physician assistant education. “The strength of UNC as a leader in educating a broad spectrum of health professionals insures that the UNC Physician Assistant program is on trajectory to becoming a premier program nationally,” he said.

Areas of Expertise (7)

Primary Care

Resident Education

Genreal Internal Medicine

Pain Management

Opioid Management

Substance Abuse

Quality Improvement

Accomplishments (2)

Co-Founder and Director: UNC General Medicine Pain Service (professional)

Helped create the UNC General Medicine Pain Service

Founding Program Director: UNC Physician Assistant Program (professional)

Founded the UNC Physician Assistant Program

Education (3)

University of North Carolina School of Medicine: M.D., Medicine

Duke University: B.A., Medieval and Renaissance Studies

University of North Carolina at Chapel Hill School of Public Health: Masters, Public Health

Affiliations (2)

  • Physician Assistant Program Director
  • Associate Professor of Medicine

Media Appearances (1)

Amid the opioid crisis, some seriously ill people risk losing drugs they depend on

The Washington Post and The Chicago Tribune  

Julie Anne Feinstein had overcome a lifetime of adversity when she began taking daily medication for pain 10 years ago at age 68, prescriptions that would eventually land her at the center of the nation’s opioid crisis. She had survived paralyzing childhood polio to become a skiing, mountain-climbing teenager near her home in Oregon. When post-polio syndrome struck at age 36, causing muscle weakness, fatigue and pain, and making her work as a classroom teacher difficult, the mother of four earned a degree in special education so she could work with visually impaired students, a job she could do while seated. When she was 62, a blind student accidentally knocked her to the ground, an injury that led to a spinal fusion — her second — and ended her career. Unable to manage daily tasks, Feinstein moved to an assisted living center in Portland and began using an electric wheelchair.

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Articles (6)

Short-Acting Opioids Are Associated with Comparable Analgesia to Long-Acting Opioids in Patients with Chronic Osteoarthritis with a Reduced Opioid Equivalence Dosing

Pain Medicine, November 2017

Ameer Ghodke, Stephanie Barquero, Paul R Chelminski, Timothy J Ives

Setting: There are no studies that exist within the primary care setting that address optimal opioid therapy in osteoarthritis patients. In light of the recently released US Centers for Disease Control and Prevention guidelines on opioid use in chronic noncancer pain, there is a pressing need to better characterize the effectiveness of long- and short-acting opioids. Objective: To examine the effectiveness of short-acting opioids (SAO) vs long-acting opioids (LAO) and combination therapies (SAO and LAO) for treating chronic osteoarthritis pain in a retrospective trial. Methods: Average and lowest pain scores approximately one to two weeks prior to patient appointments were collected and averaged for both SAO and LAO patients who were actively enrolled in a pain clinic at an academic medical center. Results: There was no statistical difference between reported average and low pain scores for the SAO vs LAO groups (P = 0.201 and P = 0.296, respectively), although the SAO group on average had a significantly lower morphine equivalence (P < 0.001). Various covariates for both groups were tested in an adjusted model to look at trends in the use of nonopioid medications (i.e., acetaminophen, nonsteroidal anti-inflammatory drugs, antidepressants, and adjunct analgesic agents). No significant differences in pain scores existed when comparing covariates for the SAO vs LAO groups. Conclusions: The study suggests that in addition to being effective, short-acting opioid medications may also provide a safer and cheaper alternative to long-acting opioid therapies in the treatment of chronic osteoarthritis. Perspective: This article investigates the effectiveness of short-acting vs long-acting opioids for the treatment of chronic noncancer pain, specifically osteoarthritis. This information could potentially aid practitioners in primary care environments to design equally efficacious and less costly opioid regimens, while simultaneously enhancing patient safety.

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The Accuracy of a Fibromyalgia Diagnosis in General Practice

Pain Medicine, July 2017

Rosalind Gittins, Molly Howard, Ameer Ghodke, Paul Chelminski

Abstract Objective: To compare the characteristics of people with fibromyalgia (FM) with those with other forms of nonmalignant chronic pain. Design: A prospective cohort study conducted in a chronic pain management clinic within an academic medical center. Setting. : Many symptoms of the chronic pain syndrome FM are common to other pain or musculoskeletal syndromes. FM may be misdiagnosed by clinicians. Subjects: Thirty-three patients with a working diagnosis of FM were identified: 26 (78.8%) participated in the study. They were matched by age (mean = 53.0 years) and gender (80.8% female) to a control group with other forms of chronic nonmalignant pain. Methods: Standardized physical examinations for FM were undertaken using the 1990 and revised 2010 American College of Rheumatology (ACR) guidelines. The groups were compared using diagnoses of psychiatric disorders and responses to the Pain Disability Index, Personal Health Questionnaire, Revised Fibromyalgia Impact Questionnaire, and Rapid Estimate Adult Literacy in Medicine. Results: The most common psychiatric disorders were depression (44.4%) and anxiety (27.3%). Incidence of at least one psychiatric condition was 80.8%, and the only difference ( P = 0.002) between the two populations was the mean number of tender points: 5.6 (±4.2) vs controls 3.2 (±2.2). Only three (11.5%) participants with a prior diagnosis of FM fulfilled the 1990 ACR diagnostic criteria, increasing to 38.5% when the 2010 criteria were applied; however, 46.1% of controls also met the revised diagnostic criteria. Conclusions: FM is commonly misdiagnosed: all patients with a working diagnosis should be reassessed and reviewed to ensure that the most appropriate treatment is provided.

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Application Inflation for Internal Medicine Applicants in the Match: Drivers, Consequences and Potential Solutions

The American Journal Of Medicine, May 2016

Anne G. Pereira, Paul R. Chelminski, Shobhina G. Chheda, T. Robert Vu

Application Inflation for Internal Medicine Applicants in the Match: Drivers, Consequences and Potential Solutions

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The Quandary of Improving Hypertension Control in Diabetes

Clinical Diabetes, October 2008

P. Chelminski, M. Pignon

The Quandary of Improving Hypertension Control in Diabetes

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Conception as a Potential Consequence of Diabetes Treatment

Clinical Diabetes, April 2008

A. B. Guirguis, P. R. Chelminski, R. M. Malone, M. Pignone

M.M. is a 45-year-old white woman with a medical history of type 2 diabetes, polycystic ovarian syndrome (PCOS), hypertension, and gastroesophageal reflux disease. She had a history of one normal, healthy pregnancy and delivery without complication. The patient was diagnosed with diabetes in 1994, and after 2000 developed painful diabetic neuropathy and microalbuminuria. At 42 years of age, she was being followed by both her primary care physician (PCP) and collaboratively by a clinical pharmacist within the same academic practice. At that time, she was prescribed 30 mg pioglitazone daily, 1,000 mg metformin twice daily, 10 mg glipizide twice daily, 2.5 mg enalapril daily, 25 mg hydrochlorothiazide daily, and 81 mg aspirin daily. For neuropathic pain, she was receiving 5 mg methadone three times daily, 300 mg gabapentin three times daily, and 40 mg fluoxetine daily. She had been receiving metformin since 2001, and pioglitazone since 2003. At the time of pioglitazone initiation, she was counseled regarding the possible effects of the medication on increasing fertility in women with PCOS. She said she did not want to become pregnant, but she refused hormonal contraceptives or an intrauterine device. Both she and her husband were counseled to use barrier contraception methods. By February 2004, her pioglitazone had been titrated to 30 mg once daily. Her weight was 233 lb and height 64 inches, for a BMI of 40 kg/m2. Her most recent hemoglobin A1c (A1C) was 6.2%, and her serum chemistries were within normal limits. Her PCP noted that she was recently nonadherent with both glipizide and metformin because of her concern about low blood glucose. Discussion revealed …

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Crossing the Cultural Chasm

Annals of Internal Medicine, August 2007

P. Chelminski

Crossing the Cultural Chasm

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