Telecare approach improves chronic musculoskeletal pain management

By Lucy Piper, Senior medwireNews Reporter

A collaborative care approach delivered by telephone is effective for managing chronic musculoskeletal pain, show findings from the Stepped Care to Optimize Pain Care Effectiveness (SCOPE) study.

Patients who received the intervention, which involves automated symptom monitoring along with an algorithm-guided stepped care approach to optimising analgesics, were twice as likely as those receiving usual care from their primary physician to experience at least a 30% improvement in their pain score by 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 by 6 months as those in the usual care group (19.2 vs 36.0%).

“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”, Kroenke pointed out 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 prior to intervention. For more than two-thirds of patients pain symptoms had lasted for longer than 5 years.

At the end of 12 months of treatment, the 124 patients randomly assigned to the telecare intervention had a 1.02-point lower BPI score than the 126 patients receiving usual care (3.57 vs 4.59).

“The more than 1-point improvement in BPI total score at 12 months is clinically important and represents a moderate treatment effect size of 0.57”, the researchers report in JAMA.

The number needed to treat for a 30% improvement was just 4.1. And patient satisfaction with treatment was greater with the telecare approach than usual care.

At the start of the study, one-third of patients were taking opioid therapy, but few patients in either group were started on opioids or had their dose escalated.

“The intervention was effective, even though most trial participants reported pain that had been present for many years, that involved multiple sites, and that had been unsuccessfully treated with numerous analgesics,” the researchers comment.

They conclude: “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.”

In a related editorial, Michael Ohl and Gary Rosenthal, from University of Iowa Hospitals and Clinics in Iowa City, USA, highlight the attractive features of the telecare intervention. These include the telephone delivery, which makes it more accessible to patients, and the use of nurse care managers to oversee symptom monitoring, enabling implementation without the need for additional time or effort from primary care clinicians and the ability to meet high demand in already overburdened primary care practices.

But the editorialists note the need for additional studies “to determine the generalizability, sustainability, and cost-effectiveness of this strategy”.

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