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Telecare shows promise to monitor chronic pain

Thursday July 17, 2014
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A telephone-delivered intervention, in which nurses are in regular contact with patients and help develop a treatment plan, produces clinically meaningful improvements for chronic musculoskeletal pain, according to a new study published in the July 16 issue of JAMA, which looked at optimizing management of pain medications.

In the study, Kurt Kroenke, MD, of Roudebush VA Medical Center, Indiana University School of Medicine and the Regenstrief Institute, all in Indianapolis, and colleagues followed 250 patients with chronic musculoskeletal pain. The patients were assigned randomly to either an intervention group (124 patients) or to a usual care group (126 patients) whose members received pain care from their primary care physicians.

The intervention group received 12 months of telecare management that included automated symptom monitoring with an algorithm-guided approach to optimizing pain medications. A nurse case manager met with each patient in the group to take a detailed pain history and record all present and past treatments. After developing a treatment plan with the primary care physician, the nurse called and explained the plan to the patient within the first week of the study. Calls with the nurse were scheduled at one and three months, but information patients reported could also prompt a nurse call, according to a news release.

The key findings include:
• Patients in the intervention group were nearly twice as likely to report at least a 30% improvement in their pain score by 12 months (51.7% vs. 27.1%).
• The intervention was associated with clinically meaningful improvements in pain and a greater rate of improvement (56% vs. 31%).
• Patients in the usual care group were almost twice as likely to experience worsening of pain by six months compared with those in the intervention group (36% vs. 19%).
• Few patients in either group were started on opioids or had escalations in their opioid dose during the study period.
• Patients in the intervention group also were more likely to rate as “good to excellent” the medication prescribed for their pain (73.9% vs. 50.9%) and the overall treatment of their pain (76.7% vs. 51.6%).

“The intervention was effective, even though most trial participants reported pain that had been present for many years, that involved multiple sites, and that had been unsuccessfully treated with numerous analgesics,” the authors wrote. “The improvement in pain with minimal opioid initiation or dose escalation is noteworthy, given increasing concerns about the consequences of long-term opioid use.”
According to the researchers, the results of this trial, along with findings from a previous trial conducted among patients with cancer, show algorithm-guided optimization of pain medication can be efficiently delivered through a predominantly telephone and Internet-based approach.

The cost of healthcare due to pain ranges from $560 billion to $635 billion in the U.S., which combines the medical costs of pain care and the economic costs related to disability days and lost wages and productivity, according to an Institute of Medicine report.

Musculoskeletal pain accounts for nearly 70 million outpatient visits in the U.S. each year, according to the National Research Council and the IOM.

The authors noted that more research is needed to determine the cost-effectiveness and flexibility of the telecare strategy, and how it can be incorporated into primary care practices.

Study abstract: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2014.7689


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