Automated Self-management (ASM) vs. ASM-Enhanced Collaborative Care for Chronic Pain and Mood Symptoms: the CAMMPS Randomized Clinical Trial

Kurt Kroenke, Fitsum Baye, Spencer G. Lourens, Erica Evans, Sharon Weitlauf, Stephanie McCalley, Brian Porter, Marianne S. Matthias, Matthew J. Bair

Research output: Contribution to journalArticle

Abstract

Background: Chronic musculoskeletal pain is often accompanied by depression or anxiety wherein co-occurring pain and mood symptoms can be more difficult to treat than either alone. However, few clinical trials have examined interventions that simultaneously target both pain and mood conditions. Objective: To determine the comparative effectiveness of automated self-management (ASM) vs. ASM-enhanced collaborative care. Design: Randomized clinical trial conducted in six primary care clinics in a VA medical center. Participants: Two hundred ninety-four patients with chronic musculoskeletal pain of at least moderate intensity and clinically significant depressive and/or anxiety symptoms. Intervention: ASM consisted of automated monitoring and 9 web-based self-management modules. Comprehensive symptom management (CSM) combined ASM with collaborative care management by a nurse-physician team. Both interventions were delivered for 12 months. Main Measures: Primary outcome was a composite pain-anxiety-depression (PAD) z-score consisting of the mean of the BPI, PHQ-9, and GAD-7 z-scores: 0.2, 0.5, and 0.8 represent potentially small, moderate, and large clinical differences. Secondary outcomes included global improvement, health-related quality of life, treatment satisfaction, and health services use. Key Results: Both CSM and ASM groups had moderate PAD score improvement at 12 months (z = − 0.65 and − 0.52, respectively). Compared to the ASM group, the CSM group had a − 0.23 (95% CI, − 0.38 to − 0.08; overall P =.003) greater decline in composite PAD z-score over 12 months. CSM patients were also more likely to report global improvement and less likely to report worsening at 6 (P =.004) and 12 months (P =.013). Conclusions: Two intervention models relying heavily on telecare delivery but differing in resource intensity both produced moderate improvements in pain and mood symptoms. However, the model combining collaborative care led by a nurse-physician team with web-based self-management was superior to self-management alone. Trial Registration: ClinicalTrials.gov: NCT0175730.

Original languageEnglish (US)
Pages (from-to)1806-1814
Number of pages9
JournalJournal of general internal medicine
Volume34
Issue number9
DOIs
StatePublished - Sep 15 2019

Keywords

  • anxiety
  • clinical trial
  • collaborative care
  • depression
  • pain
  • telemedicine

ASJC Scopus subject areas

  • Internal Medicine

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