Telecare Shows Benefits in Treatment of Patients with Chronic Pain

Internal Medicine World ReportAugust 2014

As the practice of telecare continues to gain momentum, a group of researchers conducted a study to test how effective that course of treatment is in patients with chronic illnesses.

As the practice of telecare continues to gain momentum, a group of researchers conducted a study to test how effective that course of treatment is in patients with chronic illnesses.

The Stepped Care to Optimized Pain Care Effectiveness (SCOPE) study, published in the Journal of the American Medical Association was described by the authors as a “randomized trial comparing a telephone-delivered collaborative care management intervention vs. usual care.”

Patients dealing with pain cost the country’s healthcare system more than $600 billion in healthcare and lost productivity according to the authors. Patient treatment include between 10 to 15% taking analgesics and others taking opioids. The authors suggested that finding the most effective treatments possible would be beneficial to patients and healthcare professionals alike.

Using a pool of 250 patients with chronic musculoskeletal pain of at least moderate intensity, the authors utilized 5 primary care clinics associated with a Veterans Affairs medical center between June of 2010 and May of 2012 with a final follow-up finished by June of 2013. The authors defined chronic pain as lasting longer than 3 months and rated the pain as being greater than 5 on the Brief Pain Inventory [BPI].

From the total group of participants, 124 were placed into an intervention group which included 12 months of telecare management and automated monitoring while the rest were placed in a usual care group.

According to the authors, the final results showed an average BPI in the intervention and control groups were 5.31 (1.81) and 5.12 (1.80), respectively. That was 1.02 points lower than the standard care group (95%CI, -1.58 to -0.47) BPI score at 12 months (3.57-4.59). They also reported 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, 19. [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.” They also reported an improvement in secondary pain among the group members with few requiring opioid initiation or escalation.

“Telecare collaborative management increased the proportion of primary care patients with improved chronic musculoskeletal pain,” the authors noted. “This was accomplished by optimizing nonopioid analgesic medications using a stepped care algorithm and monitoring.”

The authors were also encouraged by opioid usage, during the study, showing no signs of escalating. “The improvement in pain with minimal opioid initiation or dose escalation is noteworthy, given increasing concerns about the consequences of long-term opioid use,” they said. “The results of SCOPE, coupled with findings from a previous trial conducted among patients with cancer show that algorithm-guided optimization of analgesic therapy can be efficiently delivered through a predominantly telephone and Internet-based approach.”

The study was supported by a Department of Veterans Affairs Health Services Research and Development Merit Review award and a VA Career Development award. One author reported a connection to the pharmaceutical industry.

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