Improving Chronic Pain Control with Home Monitoring

Improving Chronic Pain Control with Home Monitoring

Chronic pain is one of the most prevalent, costly, and disabling medical disorders of modern times. While many studies have focused on causes and treatment options to improve chronic pain, few trials have examined interventions by primary care physicians.

Promising research was recently published in The Journal of the American Medical Association. Dr. Kurt Kroenke, professor of medicine, research scientist and lead author, wanted to determine the effectiveness of a “telecare intervention” for chronic pain.

The intervention included monitoring of pain using automated phone calls or the Internet with contacts by a nurse care manager over 12 months. These nurses met weekly with a physician pain specialist to discuss treatment of new patients or concerns over patients already being followed who were not improving.

Results showed that twice as many patients in the telecare group had improvement in their pain compared to the usual care control group (52% vs. 27%). Surprisingly, nearly twice as many patients in the usual care group got worse over 12 months (36% vs. 19%).  Therefore, patients with chronic pain may not only fail to improve with standard treatment, they may in fact can get worse over time.

One-third of the chronic pain patients were on opioids at the start of the study and very few patients needed to start or increase dosage. The intervention group was divided between those who chose to do automated symptom monitoring (51%) or internet (49%). The majority of patients considered the monitoring as easy to do, and claimed the telecare intervention was helpful to them. Patients often had pain for many years, in more than one area of the body, and had tried multiple treatments

The scientific evidence shows that chronic pain can be improved by changing or adjusting medications without increasing the use of opioids. Furthermore, this can be done through a largely telecare approach combining home-based pain monitoring using automated phone calls or an Internet (web-based) approach with a nurse care manager-physician team.

Prescription painkillers are highly addictive and long-term use increases the risk. Discuss personal concerns with your physician including possible holistic approaches for pain control.

http://jama.jamanetwork.com/article.aspx?articleid=1887761

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