A collaborative intervention designed to help primary care practitioners improve management of chronic pain was found to be modestly but significantly effective, according to data from a cluster randomized trial.
The intervention resulted in greater use of adjunctive pain medications and treatments, which meant that practitioners were acting in better accordance with guidelines for chronic pain management, said Dr. Steven K. Dobscha of the Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders at the Portland (Ore.) Veterans Affairs Medical Center and his associates.
The investigators assessed the collaborative intervention in three urban and two rural primary care clinics of the VA medical center. A total of 22 physicians, internal medicine fellows, and nurse practitioners were randomly assigned to provide usual treatment to 214 chronic pain patients, and 20 practitioners were assigned to provide care according to the collaborative intervention to 187 patients.
All patients had a diagnosis of moderate or severe musculoskeletal pain with a median of 10 years' duration, and two-thirds had more than one such diagnosis. The mean patient age was 61 years. Depression, PTSD, and panic attacks were common.
A team including a full-time psychologist care manager and an internist implemented the intervention, which included leading workshops to introduce both clinicians and patients to the intervention, assessing patients and their barriers to treatment, screening for comorbid psychiatric disorders, developing individualized functional goals, providing patient support, and providing feedback to the clinicians.
Patients in the intervention group were more likely to be prescribed adjunctive medications such as antidepressants, NSAIDs, and capsaicin, and were more likely to receive long-acting rather than standard opioids. They also were more likely to receive physical therapy than were those in the usual-care group.
After 1 year, patients in the intervention group reported “generally modest” but significant decreases in pain intensity and in pain-related disability, compared with those in the usual-care group.
A total of 22% of the intervention patients showed 30% reductions in measures of pain and disability, compared with 14% of the usual-care patients, Dr. Dobscha and his colleagues said (JAMA 2009;301:1242-52).
The intervention was similarly effective in the subgroup of chronic pain patients who had concomitant depression, showing that “improvements in pain intensity and disability can be achieved even among patients with depression,” the researchers noted.
However, there were no differences between the two treatment groups in health-related quality of life, satisfaction with health care treatment, or subjective assessments of treatment effectiveness.
The authors had no financial disclosures relating to this study.