Patients suffering from chronic pain reported at least a 30 percent reduction in pain after a year of being enrolled in a telephone and Internet-based telemedicine program, according to a JAMA study.
Telemedicine and telehealth could make a huge difference in chronic pain management in the primary care setting, where there is often a lack of resources and follow-up monitoring after the initial visit. As one recent study published in The Journal of the American Medical Association (JAMA) reveals, chronic pain can be treated effectively with minimal face-to-face interaction between clinicians and patients, if a well-designed telemedicine program is implemented.
In the study conducted by researchers at Indiana University School of Medicine, 250 patients with chronic musculoskeletal pain were randomly assigned to either a standard treatment program, or a telephone and Internet-based care program to manage their pain symptoms for a period of one year. Those enrolled in standard care received all pain management from their primary care physicians (PCPs).
Those assigned in the telemedicine program “received 12 months of telecare management that coupled automated symptom monitoring with an algorithm-guided stepped care approach to optimizing analgesics,” according to the JAMA study called SCOPE (Stepped Care to Optimize Pain Care Effectiveness). In addition to seeing a PCP, these patients connected with nurse case managers using interactive voice-recorded telephone calls or the Internet to report and monitor pain symptoms. The nurses monitored patients for non-adherence and adverse effects of medications, and implemented a “symptom-driven, stepped-care algorithm” to optimize the effect of non-opioid, non-addictive analgesics.
All patients were monitored for their Brief Pain Inventory (BPI) scores, based on self-assessed pain intensity levels that range from 0 (no pain) to 10 (severe pain), for the year-long duration of the study which involved patients from five primary care clinics under the Roudebush Veterans Administration Medical Center.
The findings revealed that “patients in the intervention group were nearly twice as likely to report at least a 30% improvement in their pain score by 12 months” compared to those who received standard care.
“Not only were chronic pain patients who received automated symptom management and calls from a nurse two times more likely to see their pain improve; patients who didn’t have this interaction were two times as likely to get worse than those who had the telecare intervention,” said Dr. Kurt Kroenke, who led the study, said in a statement. “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.”
The study indicates that patients in primary care settings can receive better pain intervention under a telemedicine program compared to standard treatment. Primary care practices are often overburdened to follow-up patients. Also, chronic pain patients in primary care settings are often referred to pain management specialists, which are not available in many areas. Using telephonic and online means of communication can overcome these hurdles and improve access to pain interventions.
According to the Institute of Medicine (IOM) report Relieving Pain in America, chronic pain is one of the main causes of work disability in the U.S., and costs the healthcare system more than $600 billion every year. Telemedicine programs can be a powerful tool to reduce costs while improving access.
The American Medical Association (AMA) recently adopted a telemedicine policy where it acknowledged the role of telemedicine in improving access to quality care. In its release, it said, “Telemedicine can strengthen the patient-physician relationship and improve access for patients to receive health care services remotely as medically appropriate including care for chronic conditions, which are proven ways to improve health outcomes and reduce health care costs.”