Article

Collaborative care for chronic pain in primary care: A cluster randomized trial. JAMA, 301, 1242-1252

Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland, OR, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 04/2009; 301(12):1242-52. DOI: 10.1001/jama.2009.377
Source: PubMed

ABSTRACT Chronic pain is common in primary care patients and is associated with distress, disability, and increased health care use.
To assess whether a collaborative intervention can improve chronic pain-related outcomes, including comorbid depression severity, in a Department of Veterans Affairs primary care setting.
Cluster randomized controlled trial of a collaborative care assistance with pain treatment intervention vs treatment as usual at 5 primary care clinics of 1 Department of Veterans Affairs Medical Center. Forty-two primary care clinicians were randomized to the assistance with pain treatment intervention group or the treatment as usual group. The 401 patients had musculoskeletal pain diagnoses, moderate or greater pain intensity, and disability lasting 12 weeks or longer and were assigned to the same treatment groups as their clinicians. Recruitment occurred from January 2006 to January 2007 and follow-up concluded in January 2008.
Assistance with pain treatment included a 2-session clinician education program, patient assessment, education and activation, symptom monitoring, feedback and recommendations to clinicians, and facilitation of specialty care.
Changes over 12 months in pain-related disability (Roland-Morris Disability Questionnaire, range of 0-24), pain intensity (Chronic Pain Grade [CPG] Pain Intensity subscale, range of 0-100), and depression (Patient Health Questionnaire 9 [PHQ-9], range of 0-27), measured as beta coefficients (difference in slopes in points per month).
Intervention patients had a mean (SD) of 10.6 (4.5) contacts with the assistance with pain treatment team. Compared with the patients receiving treatment as usual, intervention patients showed greater improvements in pain-related disability (Roland-Morris Disability Questionnaire beta, -0.101 [95% confidence interval {CI}, -0.163 to -0.040]; P = .004 and CPG Pain Intensity subscale beta, -0.270 [95% CI, -0.480 to -0.061]; P = .01). Among patients with baseline depression (PHQ-9 score > or = 10), there was greater improvement in depression severity in patients receiving the intervention compared with patients receiving treatment as usual (PHQ-9 beta, -0.177 [95% CI, -0.295 to -0.060]; P = .003). The differences in scores between baseline and 12 months for the assistance with pain treatment intervention group and the treatment as usual group, respectively, were -1.4 vs -0.2 for the Roland-Morris Disability Questionnaire, -4.7 vs -0.6 for the CPG Pain Intensity subscale, and -3.7 vs -1.2 for PHQ-9.
The assistance with pain treatment collaborative intervention resulted in modest but statistically significant improvement in a variety of outcome measures.
clinicaltrials.gov Identifier: NCT00129480.

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    • "No doubt that such complementary and alternative interventional medical procedure can be added to those programs designed to improve and manage chronic pains. Examples of collaborative interventional programs that include patients and clinicians in health education, symptom monitoring and feedback to the primary care providers, and improvements in pain-related disability and intensity, compared to usual care ones was fully demonstrated (Dobscha et al., 2009). Furthermore, being a sort of economical and effective method, cupping therapy can be employed to alleviate or even cure nonspecific low back pains (NLBPs), therefore it might be recommended to be included and incorporated to treat and prevent all related NLBPs (Hong et al., 2006). "
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    • "Although pain is common in older adults, several treatment options exist (Planton and Edlund 2010). Diverse pain management strategies have been implemented, including pharmacological management (AGS 2009), exercise therapies (Hayden, van Tulder et al. 2005), psychological interventions (Astin, Beckner et al. 2002), self-management techniques (Ersek, Turner et al. 2004; Reid, Papaleontiou et al. 2008) and collaborative care programs, which should be considered where appropriate (Dobscha, Corson et al. 2009) (for a review, see (Bruckenthal, Reid et al. 2009)). "
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