Tele-Care Intervention Improves Chronic Pain

A telephone-delivered intervention, which included automated symptom monitoring, produced clinically meaningful improvements in chronic musculoskeletal pain compared with usual care, according to a study published in the July 16 issue of JAMA.

Kurt Kroenke, MD, Roudebush VA Medical Center, Indiana University School of Medicine, and the Regenstrief Institute, Indianapolis, Indiana, and colleagues randomised 250 patients with chronic musculoskeletal pain to an intervention group (n = 124) or to a usual care group whose members received all pain care as usual from their primary care physicians (n = 126). The intervention group received 12 months of tele-care management that included automated symptom monitoring with an algorithm-guided approach to optimising pain medications.

Among the key results of the trial:

• 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 6 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 were also more likely to rate as good to excellent the medication prescribed for their pain (73.9% vs 50.9%) as well as 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.”

The researchers added that the results, along with findings from a previous trial conducted among patients with cancer, show that algorithm-guided optimisation of pain medication can be efficiently delivered through a predominantly telephone and Internet-based approach.

In an accompanying editorial, Michael E. Ohl, MD, and Gary E. Rosenthal, MD, University of Iowa Carver College of Medicine, Iowa City, Iowa, wrote: “Historically, implementation of collaborative care innovations — such as collaborative care for depression — has been slow. However, there is reason to believe that tele-care for chronic pain can be more rapidly implemented into routine practice. Adoption of collaborative care for depression was hindered by the fee-for-service payment system, which favours procedures and in-person physician visits over team-based and between-visit care. Recent movement toward reimbursement for tele-health and between-visit care may make tele-care for pain management more attractive to primary care practices.”

“In summary, Kroenke et al describe a promising tele-care strategy that may enhance the ability of primary care practices to effectively treat patients with chronic pain,” they concluded. “Additional studies are required to determine the generalisability, sustainability, and cost-effectiveness of this strategy and to assess how it may best be incorporated within primary care practices.”