telecare approach improves the management of chronic musculoskeletal pain -
By Lucy Piper, Senior medwireNews Reporter
A collaborative approach to care by phone effective in relieving chronic musculoskeletal pain, show the results of the Stepped care to optimize the effectiveness of pain care (SCOPE) study.
patients who received the intervention, which is to automate the monitoring of symptoms with a stepped care approach guided algorithm optimization to painkillers, were two times more likely than those receiving usual care from their doctor attending to experience at least a 30% improvement in their pain score of 12 months (51.7 vs 27.1%).
The researchers, led by Kurt Kroenke (Regenstrief Institute, Indianapolis, Indiana, USA), also note that patients who received the intervention were half as likely to experience a worsening of pain 6 months than those in the usual care group (19.2 vs 36.0%).
"Our results demonstrate both the effectiveness of telecare and the risk of patient deterioration in the absence of systematic approaches to optimize pain therapy," Kroenke said in a Press release.
The study participants had experienced chronic pain of at least moderate intensity (Brief Pain Inventory [BPI] score? 5) for at least 3 months before surgery. For more than two thirds of patients with symptoms of pain lasted for more than 5 years.
At the end of 12 months of treatment, 124 patients randomly assigned to the telecare intervention had a score of 1.02 point lower BPI that 126 patients receiving usual care (3.57 vs. 4.59).
"The improvement of more than 1 point of BPI total score to 12 months is clinically important and represents an effect size of 0.57 moderate treatment," the researchers report JAMA .
The number needed to treat for an improvement of 30% was 4.1. And patient satisfaction with treatment was superior to the telecare approach than usual care.
At the beginning of the study, one third of patients were taking opioid therapy, but some patients in both groups were started on opioids or had their dose escalation.
"The intervention was effective, even though most trial participants reported pain that had been present for many years, which involved multiple sites, and who had been unsuccessfully treated with many painkillers, "the researchers comment.
They conclude: "The results of SCOPE, coupled with the results of a previous test conducted with cancer patients, show that the optimization of the algorithm-guided analgesic therapy can be delivered effectively through a telephone and mainly based on Internet approach. "
in a related editorial, Michael Ohl and Gary Rosenthal, University of Iowa Hospitals and Clinics in Iowa City, United States, highlight the interesting features of the intervention telecare. These include the provision of phone, which makes it more accessible to patients, and the use of nurse care managers to oversee the monitoring of symptoms, allowing the implementation without need extra time or effort of primary care clinicians and the ability to meet the strong demand in already overburdened primary care practices.
But the editorialists noted the need for further studies "to determine the generalizability, sustainability and the profitability of this strategy. "
medwireNews licensed by permission of Springer Healthcare Ltd. © Springer Healthcare Ltd. All rights reserved. None of these parties endorse or recommend any commercial products, services or equipment.
EmoticonEmoticon