Telecare program optimizing non-opioid chronic pain medication very effective

July 15, 2014

Chronic pain in the back, neck and other joints due to arthritis or other musculoskeletal disorders is extremely common but difficult to treat. In a new study published in the July 16 issue of Journal of the American Medical Association, primary-care patients enrolled in a 12-month telecare program optimizing non-opioid medications for chronic pain were twice as likely to see improvement as patients who received usual care for chronic pain.

In addition to experiencing improvement, patients in the telecare arm of the study reported greater satisfaction with their treatment than patients receiving usual care.

The Stepped Care to Optimize Pain care Effectiveness study, or SCOPE, was a randomized trial comparing telephone-delivered collaborative care pain management versus usual care. SCOPE enrolled 250 Richard L. Roudebush Veterans Affairs Medical Center clinic patients age 18 to 65; each participant had at least three months of of moderate or greater intensity.

"Not only were who received automated symptom management and calls from a nurse two times more likely to see their pain improve; patients who didn't have this interaction were two times as likely to get worse than those who had the telecare intervention," said Kurt Kroenke, M.D., who designed and led the SCOPE study. "Our results demonstrate both the effectiveness of the telecare as well as the risk of patient deterioration in the absence of systematic approaches to optimizing pain therapy."

A research scientist with the Richard L. Roudebush VA Medical Center in Indianapolis and the Regenstrief Institute and an Indiana University School of Medicine professor of medicine, Dr. Kroenke is an internist whose research and clinical practice focus on symptom management.

Both men and women were equally likely to benefit from telecare in the SCOPE study. The benefit did not vary by the age or race of the study participant. Although one-third of patients were on opioid therapy before the yearlong study began, few patients (4 percent) were prescribed opioids for the first time or had escalations in opioid dosage.

"Relieving Pain in America," a 2011 report from the Institute of Medicine, highlights the enormous functional and economic impact of musculoskeletal pain. According to the IOM report, pain is a leading cause of work disability and costs the United States more than $600 billion annually in health care and lost productivity.

SCOPE telecare was delivered in collaboration with the study participants' primary-care physician via two avenues.

  • Automated symptom monitoring—either by interactive voice-recorded phone calls (selected by 51 percent of intervention patients) or over the Internet (selected by 49 percent)—was scheduled weekly for the first month, every other week for months two and three, and monthly for month four through 12.
  • Pain management focusing on the use of non-opioid therapies by a nurse care manager/physician pain specialist team was provided throughout the course of the study. Non-opioid therapies included five categories of non-addictive pain relievers.

Unlike his previous studies of depression patients that showed rapid initial improvement with telecare, Dr. Kroenke found in the SCOPE study that for chronic pain, improvement was gradual over the year. He notes that patience by , families and physicians is required to see reduction in chronic pain.

Explore further: Pain training for primary care providers

More information: Paper: DOI: 10.1001/jama.2014.7689
Editorial: DOI: 10.1001/jama.2014.7690

Related Stories

Pain training for primary care providers

March 5, 2013

Patients who experience chronic pain may experience improvement in symptoms if their primary care providers are specifically trained in multiple aspects of pain, including emotional consequences.

Understanding and managing chronic pain

July 4, 2014

Acupuncture, exercise and massage and physical therapy are among the ways to deal with chronic pain that don't require narcotic painkillers, says Nancy Elder, MD, professor of family and community medicine at the University ...

Recommended for you

The 'love hormone' may quiet tinnitus

September 23, 2016

(HealthDay)—People suffering from chronic ringing in the ears—called tinnitus—may find some relief by spraying the hormone oxytocin in their nose, a small initial study by Brazilian researchers suggests.

Bile acid uptake inhibitor prevents NASH / fatty liver in mice

September 21, 2016

Drugs that interfere with bile acid recycling can prevent several aspects of NASH (nonalcoholic steatohepatitis) in mice fed a high-fat diet, scientists from Emory University School of Medicine and Children's Healthcare of ...

New therapeutic target for Crohn's disease

September 20, 2016

Research from the Sanford Burnham Prebys Medical Discovery Institute (SBP) identifies a promising new target for future drugs to treat inflammatory bowel disease (IBD). The study, published today in Cell Reports, also indicates ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.