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. Identifier: NCT00129480.

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Available from: Ginger Hanson, Jan 10, 2015
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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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    ABSTRACT: The present study is designed to determine whether chronic pain syndrome (lower and upper back pain) before and after cupping is the same or there are significant treatment differences. Perception due to cupping of here and now pain sensation; sensation of pain at worst conditions; sensation of pain at best conditions; and tolerated sensation of pain; all before and after cupping were rated on 0 to 10 pain scale. It was hypothesized that there is a significant statistical difference before and after cupping, and cupping is effective in lessening and desensitizing chronic pain among lower and upper back pain subjects. Subjects were drawn on convenience sampling basis, where 95 males and females were recruited for the purpose of investigation. Results indicate that cupping therapy is effective procedure in reducing and alleviating chronic pain, where true statistical differences were obtained. It was found after the study that cupping therapy as an alternative medical technique is an effective and fruitful enough either for the management of upper and lower back pain or the control of such annoying medical conditions.
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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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    ABSTRACT: Pain is a frequent and debilitating problem among older adults, decreasing quality of life (QOL) both physically and mentally. The burden of arthritis, sciatica, and back pain on QOL was estimated using ordinary least squares regression techniques to estimate the impact of each of these types of pain on QOL, controlling for patient demographic, socioeconomic, and health status characteristics. For individuals with arthritis, sciatica, and back pain, the adjusted average physical component scores were 4.19, 1.39, and 6.75 points lower, respectively (all p < 0.0001), than those without pain. Adjusted average mental component scores were 1.33, 0.47, and 2.93 points lower (all p < 0.01) for individuals with arthritis, sciatica, and back pain, respectively. The impact of pain on QOL was greater than that for many other commonly treated medical conditions. Clinicians should discuss pain with their patients to maximize their QOL.
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    • "Lin et al. (2003) found that comprehensive, integrated depression care reduced depression symptoms, decreased pain, and improved functional status in a population of older adults with arthritis and comorbid depression. Similar to other literature that has noted the strong relationship between depression and function disability among those with chronic pain (Dobscha et al., 2009; Lin et al., 2003; West et al., 2010), we found that among those unable to work with high depression symptoms, more than 9 out of 10 (92%) reported a high level of interference with daily activities, suggesting very high disability among this group. Even among the individuals with a low level of depression symptoms who were unable to work, more than three quarters (76%) reported a high level of interference with daily activities. "
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    ABSTRACT: This study of 2,163 adult chronic, non-cancer-pain, long-term opioid therapy patients examines the relationship of depression to functional disability by measuring average pain interference, activity limitation days, and employment status. Those with more depression symptoms compared to those with fewer were more likely to have worse disability on all 3 measures (average pain interference score >5, OR = 5.36, p < .0001; activity limitation days ≥ 30, OR = 4.05, p < .0001; unemployed due to health reasons, OR = 4.06, p < .0001). Depression might play a crucial role in the lives of these patients; identifying and treating depression symptoms in chronic pain patients should be a priority.
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