Combination Therapy Significantly Lowers Pain Symptoms

A “collaborative care intervention” that includes education for patients and physicians, symptom monitoring, and feedback for the primary care physician can lead to a reduction in pain-related disability and intensity when compared with traditional care practices, a new study from the Portland VA Medical Center has found.

Steven K. Dobscha, MD, and colleagues of the Portland VA Medical Center in Portland, OR examined how a multi-faceted approach to pain management may reduce disability and symptoms of pain. Treatment for participants included “a 2-session clinician education program, patient assessment, education and activation, symptom monitoring, feedback and recommendations to clinicians and facilitation of specialty care.” After one year, patients who followed the specialized course of treatment expressed a significantly lower level of pain-related disability and symptoms of pain, compared with patients who followed a traditional treatment regimen. According to the JAMA release, “At 12 months, 21.9 percent of intervention patients vs 14.0 percent of treatment as usual patients demonstrated 30 percent reductions in a measure of pain-related disability.”

Patients were also evaluated for depressive symptoms. After one year, intervention-treated participants showed “significantly greater improvements on a measurement of depression.” In addition to the one-year findings, at the halfway point in the study patients undergoing the treatment tailored for study purposes said they felt their pain had significantly improved.

The study included 401 patients across five primary care clinics. Forty-two primary care physicians were randomly assigned to assist with intervention groups or “treatment as usual groups.” Participants had been diagnosed with muscoskeletal pain problems that were either of “moderate or great pain intensity,” and had been impacted by a disability that lasted for three or more months. They were also “assigned to the same treatment groups as their clinicians.”

“Overall, this study showed that a collaborative care intervention for chronic pain was significantly more effective than treatment as usual across a variety of outcome measures,” said researchers. “Although many of the improvements were modest, they may be especially meaningful because patients in our sample were older, had long-standing pain, multiple medical problems, and reported high baseline rates of disability… Our results add to the growing body of literature suggesting that the collaborative care model is effective in improving clinical outcomes and adherence to treatment guidelines across a variety of chronic conditions."

To see the study abstract, click here.