Study Suggests Primary Care-Based Collaborative Care for Chronic Pain More Effective than Usual Care
KEY FINDINGS:
- A primary care-based collaborative care intervention for chronic pain was significantly more effective than usual care across a variety of outcome measures, including pain disability and intensity. However, these improvements were generally modest.
- Depression severity and pain disability and intensity improved among Veterans in the intervention group who reported both chronic pain and depression.
- Greater use of adjunctive pain medications and long-term opioids among the intervention group suggested that the intervention contributed to the delivery of guideline-concordant care.
BACKGROUND:
Chronic non-cancer pain is associated with considerable physical and psychosocial impairment, distress, comorbid depression, and increased healthcare use and costs. Guidelines for chronic pain have been developed but implementation has been problematic, particularly in busy primary care settings. The Study of the Effectiveness of a Collaborative Approach to Pain (SEACAP) assessed whether a collaborative care intervention would improve pain-related outcomes - primarily pain-related disability and intensity - over 12 months, compared to treatment as usual (TAU). Investigators also assessed depression severity. The SEACAP intervention included: a two-session clinician education program; patient assessment, education and activation; symptom monitoring; feedback and recommendations to clinicians; and facilitation of specialty care. All Veterans and clinicians participating in TAU had access to the specialty pain clinic, ancillary services (i.e., physical and occupational therapy), and mental health services. Study participants were 401 Veterans being treated at five primary care clinics of one VA medical center, and 42 primary care clinicians. Clinicians were randomized to the intervention or TAU; Veterans were assigned to the same group as their clinicians, with 214 Veterans assigned to the intervention and 187 to TAU. Veterans in this study were diagnosed with musculoskeletal pain (back, arthritic, neck or joint) of moderate or greater severity, and with a duration of at least 12 weeks.
LIMITATIONS:
- Veterans volunteered to participate in this study so may have been particularly motivated.
- Results were obtained from only one VA medical center.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D. Drs. Dobscha, Corson, Leibowitz, and Gerrity, and Ms. Dickinson are part of HSR&D's Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders.
PUBLICATION DATE:
March 25, 2009 in Journal of the American Medical Association (JAMA)
Dobscha SK, Corson K, Perrin NA, Hanson GC, Leibowitz RQ, Doak MN, Dickinson KC, Sullivan MD, Gerrity MS. Collaborative care for chronic pain in primary care: a cluster randomized trial. JAMA 2009 Mar 25;301(12):1242-52.
