Telecare collaborative management of chronic pain in primary care a randomized clinical trial

Kurt Kroenke, Erin E. Krebs, Jingwei Wu, Zhangsheng Yu, Neale R. Chumbler, Matthew J. Bair

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

IMPORTANCE: Chronic musculoskeletal pain is among the most prevalent, costly, and disabling medical disorders. However, few clinical trials have examined interventions to improve chronic pain in primary care. OBJECTIVE: To determine the effectiveness of a telecare intervention for chronic pain. DESIGN, SETTING, AND PARTICIPANTS: The Stepped Care to Optimize Pain Care Effectiveness (SCOPE) study was a randomized trial comparing a telephone-delivered collaborative care management intervention vs usual care in 250 patients with chronic (≥3 months) musculoskeletal pain of at least moderate intensity (Brief Pain Inventory [BPI] score ≥5). Patients were enrolled from 5 primary care clinics in a single Veterans Affairs medical center from June 2010 through May 2012, with 12-month follow-up completed by June 2013. INTERVENTIONS: Patients were randomized either 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 telecare management that coupled automated symptom monitoring with an algorithm-guided stepped care approach to optimizing analgesics. MAIN OUTCOMES AND MEASURES: Primary outcomewas the BPI total score, which ranges from 0 ("no pain") to 10 ("pain as bad as you can imagine") and for which a 1-point change is considered clinically important. Secondary pain outcomes included BPI interference and severity, global pain improvement, treatment satisfaction, and use of opioids and other analgesics. RESULTS: Overall, mean (SD) baseline BPI scores in the intervention and control groups were 5.31 (1.81) and 5.12 (1.80), respectively. Compared with usual care, the intervention group had a 1.02-point lower (95% CI, -1.58 to -0.47) BPI score at 12 months (3.57 vs 4.59). 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%; relative risk, 1.9 [95% CI, 1.4 to 2.7]), with a number needed to treat of 4.1 (95% CI, 3.0 to 6.4) for a 30% improvement. Secondary pain outcomes also improved. Few patients in either group required opioid initiation or dose escalation. CONCLUSIONS AND RELEVANCE: Telecare collaborative management increased the proportion of primary care patients with improved chronic musculoskeletal pain. This was accomplished by optimizing nonopioid analgesic medications using a stepped care algorithm and monitoring. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00926588

Original languageEnglish (US)
Pages (from-to)240-248
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume312
Issue number3
DOIs
StatePublished - Jan 1 2014

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Chronic Pain
Primary Health Care
Randomized Controlled Trials
Pain
Musculoskeletal Pain
Equipment and Supplies
Opioid Analgesics
Non-Narcotic Analgesics
Numbers Needed To Treat
Primary Care Physicians
Veterans
Telephone
Analgesics
Clinical Trials

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Telecare collaborative management of chronic pain in primary care a randomized clinical trial. / Kroenke, Kurt; Krebs, Erin E.; Wu, Jingwei; Yu, Zhangsheng; Chumbler, Neale R.; Bair, Matthew J.

In: JAMA - Journal of the American Medical Association, Vol. 312, No. 3, 01.01.2014, p. 240-248.

Research output: Contribution to journalArticle

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