A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity Public Deposited

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Creator
  • Ives, Timothy
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics, School of Medicine, Department of Medicine
  • Pignone, Michael
    • Affiliation: School of Medicine, Department of Medicine
    • Other Affiliation: Robert Wood Johnson Clinical Scholars Program
  • Bryant, Mary E.
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics, School of Medicine, Department of Medicine
  • Felix, Katherine M.
    • Affiliation: School of Medicine, Department of Medicine
  • Perhac, J. Stephen
    • Affiliation: School of Medicine, Department of Medicine
  • Chelminski, Paul R.
    • Affiliation: School of Medicine, Department of Medicine
  • Malone, Robert M.
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmacotherapy and Experimental Therapeutics, School of Medicine, Department of Medicine
  • DeWalt, Darren A
    • Affiliation: Robert Wood Johnson Clinical Scholars Program, School of Medicine, Department of Medicine
  • Miller, Thomas M.
    • Affiliation: School of Medicine, Department of Medicine
  • Prakken, Steven D.
    • Affiliation: School of Medicine, Department of Medicine
Abstract
  • Abstract: Background: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. Methods: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. Results: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). Conclusions: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.
Date of publication
Identifier
  • doi:10.1186/1472-6963-5-3
  • 15649331
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Paul R Chelminski et al.; licensee BioMed Central Ltd.
License
Journal title
  • BMC Health Services Research
Journal volume
  • 5
Journal issue
  • 1
Page start
  • 3
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1472-6963
Bibliographic citation
  • BMC Health Services Research. 2005 Jan 13;5(1):3
Access
  • Open Access
Publisher
  • BioMed Central Ltd
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