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Chronic Pain Can Be Treated Better with Collaberative Treatments, study shows

Posted Apr 05 2009 11:39pm

Chronic pain affects 15% of the United States population. Often times chronic pain management consists of only treating the pain aspect and places little emphasis on how this pain affects patients day to day. Patients who suffer with chronic pain often turn to medications for treatment- chronic pain can lead to increased overall stress, anxiety and often depression. Unfortunately, depression is often not addressed when treated for chronic pain, and it can make it more difficult to follow through with recommended therapies.

A new March 2009 study published in Journal of the American Medical Association shows that when patients are treated with a team of Doctors approach, treatment can be more effective. This team approach includes psychotherapy to deal with depression. This was compared to how chronic pain is treated conventionally- by only medication, therapy or surgery sometimes

Dr. Steven K. Dobscha, of Portland VA Medical Center in Oregon, looked at 401 people with an average age of 61 or 62 who were in chronic pain for at least three months. (They excluded those diagnosed with chronic fatigue syndrome or fibromyalgia.) The study, which took place in the Department of main purpose was to determine if chronic pain can be treated more effectively if different types of treatment is used collaboratively. The 401 participants in this study has musculoskeletal pain of moderate or greater pain intensity and disability that lasted 3 months or longer.

There were two groups in this study. The first group was treated for chronic pain by a team of doctors using a variety of treatment methods, including a psychologist. Treatment included workshops for further education on pain treatment, patient assessment, education and activation, symptom monitoring, feedback and recommendations to clinicians, and facilitation of specialty care. In this particular group the psychologist talked to patients about their treatment and their goals for care, and the team came up with a treatment plan that was e-mailed to the patient's doctor or posted in an alert in the patient's medical record. People who needed more intensive care such as an an additional consultation with a mental health professional -- received it. Over the course of a year, patients with the pain-treatment team had an average of about 10 or 11 meetings or other contacts with their team members, unlike people with regular care.

The second group was treated as usual at the Veterans Affairs Medical center, no extra counseling or intervention.

The results were measured over 12 months by using questionnaires that asked patients their pain level and intensity and how it affected their activities of daily living. Also the participants were given a Depression health questionnaire. It was found that participants in the pain treatment team showed greater improvement in pain related disability and also a decrease in depression was seen.

"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. 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. Patients in many health care systems and private group practices have limited access to specialty chronic pain services. A primary care–based intervention can have positive effects on pain disability and intensity, and on depressive symptoms," the authors concluded. Helping patients with chronic pain in a collaborative method with a team of doctors resulted in resulted in modest but statistically significant improvement in a variety of outcome measures.

What are the solutions for chronic pain?This study shows us that simply using one method such as medication or turning to surgery may not be the answer. There are a multiplicity of factors that play a role. Just taking medications can lead to an unhealthy dependence and unwanted side effects that may require more medications. Surgery itself can be a risky, require longer recovery and rehabilitation and again, require the patient to take more medications. Also both of these solutions (medications or surgeries) can cost more in the long term- to both the patient and the health

Chronic pain can easily lead people into depression. This type of pain affects your day to day activities- including your personal and work environment. Not being able to fully participate in family events can lead to anxiety, sadness and depression. Treatment needs to involve different health professionals including psychologists. Just talking to patients and understanding what is on their mind, what is causing them anxiety can make such a big difference in how chronic pain is dealt with. Family members are not trained to handle chronic pain- that is why talking to a professional can be of aid. Simple encouragement, reassurance, answers to why things are the way they are, and options avaialbe for chronic pain- can make a big difference in how chronic pain is dealt with and how effective the treatment is.

Article Source: Jama 2009;301(12):1242-1252. Collaborative Care for Chronic Pain in Primary Care

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