Collaborative Care Helps Ease Chronic Pain

By Serena Gordon
HealthDay Reporter

TUESDAY, March 24 (HealthDay News) -- A team effort may be a better approach to helping people battle chronic pain, new research suggests.

In a study including more than 400 U.S. veterans, researchers found that a collaborative strategy for chronic pain management -- one that included education for patients in pain and their primary care doctors, as well as frequent reevaluation of how the pain plan was working -- provided better relief of pain compared to standard care.

"We did a randomized trial comparing collaborative care for chronic pain to people getting usual care. We did this because chronic pain is common, especially in the primary care setting, and most treatment is provided by primary care doctors," said the study's lead author, Dr. Steven K. Dobscha, acting chief of psychiatry in the mental health and behavioral neurosciences division at the Portland VA Medical Center in Oregon.

The good news from the study, said Dobscha, is that "even if you've had years of pain and multiple pain problems, there's hope."

Results of the study are published in the March 25 issue of the Journal of the American Medical Association.

For the study, researchers recruited volunteers from three urban and two rural primary care clinics that were part of the Portland VA Medical Center. All had chronic musculoskeletal pain that was of moderate or greater intensity. Most of the 401 volunteers were male -- 92% -- and the average age was 61.3 years in the intervention group and just over 62 years in the usual-care group.

Half of the group was randomly assigned to receive the collaborative care intervention, while the other half received standard care.

Dobscha said the intervention consisted of clinician and patient education, with an emphasis on teaching patients to self-manage their pain. He said one of the most important things for patients to overcome is "fear/avoidance." People who are in pain become fearful that if they participate in activities, they may exacerbate their pain problem, so they begin to avoid activity. Dobscha said this can set the patient up for even more pain problems because their muscles become deconditioned, which can then lead to a lower quality of life.

The intervention group also had a care manager -- in this study, it was a psychologist -- who would periodically contact patients to assess whether or not there had been improvement.

The researchers assessed the patients using numerous pain, disability and depression measurements at baseline and then again a year later. In one -- the Roland-Morris Disability Questionnaire -- about 22% of people in the intervention group reported a 30% or more decrease in pain compared to 14% in the usual care group, the study found.

Although seemingly modest, such improvements can be "meaningful for people with long-standing pain," Dobscha said. And, he pointed out that many of these people had been in pain for 15 years or longer. So, an intervention for someone who had a shorter-term pain problem or in a younger population might even work better.

"This was a very positive study. These patients had a level of care that is nearly parallel to a pain care center in a primary care setting," said Dr. Christopher Gharibo, medical director of pain management at the New York University Hospital for Joint Diseases in New York City. This type of collaborative care "can certainly reach out to a much greater number of people, may be more convenient for the patients and can help decrease health care costs," he said.

SOURCES: Steven K. Dobscha, acting chief, psychiatry, Mental Health and Behavioral Neurosciences division, Portland VA Medical Center, Ore.; Christopher Gharibo, M.D., medical director, pain medicine, New York University Hospital for Joint Diseases, New York City; March 25, 2009, Journal of the American Medical Association

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