Pain is a major health problem in the United States and costs the country more than $600 billion each year in lost productivity and health care.
For this study, published in the July 16 issue of the Journal of the American Medical Association, researchers evaluated telephone-delivered care within a group of 250 people with chronic musculoskeletal pain.
Participants were randomly assigned to receive either usual care from their primary care doctors or "telecare" management, which included automated symptom monitoring and use of pain medications guided by scientific methods.
After 12 months, more than half the patients in the telecare group reported at least a 30 percent improvement in their pain score, compared with about one-quarter of those in the usual-care group, the study authors found.
The telecare program "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 [painkillers]," wrote Dr. Kurt Kroenke, of Roudebush VA Medical Center and Indiana University School of Medicine in Indianapolis, and colleagues.
Patients in the telecare group were more likely to have clinically significant improvements in pain and a greater rate of improvement (56 percent versus 31 percent), the researchers reported. And they were about half as likely to experience worsening of pain after six months (19 percent versus 36 percent).
Few patients in either group started taking powerful opioid painkillers or increased their use of these drugs, the study authors noted in a journal news release.
"The improvement in pain with minimal opioid initiation or dose escalation is noteworthy, given increasing concerns about the consequences of long-term opioid use," the researchers concluded.
Moreover, three-quarters of the patients in the telecare group rated their prescribed pain medications as good-to-excellent while only half in the usual-care group did so, the investigators found. The telecare patients were also more likely to give high marks for overall treatment of their pain (about 77 percent versus 52 percent).
The authors of an accompanying journal editorial said additional studies are needed to determine the sustainability and cost-effectiveness of telecare pain management. Dr. Michael Ohl and Dr. Gary Rosenthal, of the University of Iowa Carver College of Medicine, further added that future research must assess how to incorporate telecare pain management into clinical practice.
The U.S. National Library of Medicine has more about chronic pain.
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