JAMA study: Telecare program optimizing non-opioid chronic pain medication very effective
INDIANAPOLIS -- Chronic pain in the back, neck and other joints due to arthritis or other musculoskeletal disorders is extremely common but difficult to treat. In a new study published in the July 16 issue of Journal of the American Medical Association, primary-care patients enrolled in a 12-month telecare program optimizing non-opioid medications for chronic pain were twice as likely to see improvement as patients who received usual care for chronic pain.
In addition to experiencing pain improvement, patients in the telecare arm of the pain management study reported greater satisfaction with their chronic pain treatment than patients receiving usual care.
The Stepped Care to Optimize Pain care Effectiveness study, or SCOPE, was a randomized trial comparing telephone-delivered collaborative care pain management versus usual care. SCOPE enrolled 250 Richard L. Roudebush Veterans Affairs Medical Center clinic patients age 18 to 65; each participant had at least three months of chronic musculoskeletal pain of moderate or greater intensity.
"Not only were chronic pain patients who received automated symptom management and calls from a nurse two times more likely to see their pain improve; patients who didn't have this interaction were two times as likely to get worse than those who had the telecare intervention," said Kurt Kroenke, M.D., who designed and led the SCOPE study. "Our results demonstrate both the effectiveness of the telecare as well as the risk of patient deterioration in the absence of systematic approaches to optimizing pain therapy."
A research scientist with the Richard L. Roudebush VA Medical Center in Indianapolis and the Regenstrief Institute and an Indiana University School of Medicine professor of medicine, Dr. Kroenke is an internist whose research and clinical practice focus on symptom management.
Both men and women were equally likely to benefit from telecare in the SCOPE study. The benefit did not vary by the age or race of the study participant. Although one-third of patients were on opioid therapy before the yearlong study began, few patients (4 percent) were prescribed opioids for the first time or had escalations in opioid dosage.
"Relieving Pain in America," a 2011 report from the Institute of Medicine, highlights the enormous functional and economic impact of musculoskeletal pain. According to the IOM report, pain is a leading cause of work disability and costs the United States more than $600 billion annually in health care and lost productivity.
SCOPE telecare was delivered in collaboration with the study participants' primary-care physician via two avenues.
- Automated symptom monitoring -- either by interactive voice-recorded phone calls (selected by 51 percent of intervention patients) or over the Internet (selected by 49 percent) -- was scheduled weekly for the first month, every other week for months two and three, and monthly for month four through 12.
- Pain management focusing on the use of non-opioid therapies by a nurse care manager/physician pain specialist team was provided throughout the course of the study. Non-opioid therapies included five categories of non-addictive pain relievers.
Unlike his previous studies of depression patients that showed rapid initial improvement with telecare, Dr. Kroenke found in the SCOPE study that for chronic pain, improvement was gradual over the year. He notes that patience by patients, families and physicians is required to see reduction in chronic pain.
Authors of the study in addition to Dr. Kroenke are Erin E. Krebs, M.D., of the Minneapolis VA Health Care System and University of Minnesota Medical School; Jingwei Wu, M.S., and Zhangsheng Yu, Ph.D., of the IU Department of Biostatistics; Neale R. Chumbler, Ph.D., of the College of Public Health, University of Georgia; and Matthew J. Bair, M.D., of the Roudebush VA Medical Center, the Regenstrief Institute and the IU School of Medicine.
The SCOPE study was supported by a Department of Veterans Affairs Health Services Research and Development Merit Review award to Dr. Kroenke (IIR 07-119) and Career Development Award to Dr. Krebs (CDA 07-215). The views expressed in the study are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.