Stepped Care to Optimize Pain Care Effectiveness
| Status: | Completed |
|---|---|
| Conditions: | Chronic Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 4/21/2016 |
| Start Date: | October 2009 |
| End Date: | June 2015 |
Stepped Care to Optimize Pain Care Effectiveness (SCOPE)
Pain is the most common physical symptom in primary care, accounting for an enormous burden
in terms of patient suffering, quality of life, work and social disability, and health care
and societal costs. Pain is particularly prevalent among veterans. Four major barriers to
optimal care include underdetection of pain, inadequate initial treatment, failure to
monitor adherence and symptom response, and failure to adjust treatment in patients not
responding or intolerant of initial therapy. Therefore, we propose to conduct the Stepped
Care to Optimize Pain care Effectiveness (SCOPE) study, a randomized clinical effectiveness
trial in primary care.
in terms of patient suffering, quality of life, work and social disability, and health care
and societal costs. Pain is particularly prevalent among veterans. Four major barriers to
optimal care include underdetection of pain, inadequate initial treatment, failure to
monitor adherence and symptom response, and failure to adjust treatment in patients not
responding or intolerant of initial therapy. Therefore, we propose to conduct the Stepped
Care to Optimize Pain care Effectiveness (SCOPE) study, a randomized clinical effectiveness
trial in primary care.
SCOPE will enroll 250 primary care veterans with persistent (3 months or longer)
musculoskeletal pain of moderate severity, and randomize them to either the stepped care
intervention or usual care control group. The intervention will be based upon the
empirically-validated Three-Component Model which in SCOPE will involve collaboration
between the primary care physician, a nurse pain care manager, and a supervising physician
pain specialist. SCOPE will involve a telemedicine approach coupling automated home-based
symptom monitoring with telephone-based nurse care management. The intervention will consist
of optimized analgesic management using a stepped care approach to drug selection, symptom
monitoring, dose adjustment, and switching or adding medications. All subjects will undergo
comprehensive outcome assessment at baseline, 1, 3, 6 and 12 months by interviewers blinded
to treatment group. Our principal aim is to test whether SCOPE is more effective than usual
care in reducing pain as measured by the Brief Pain Inventory. Secondarily, we will test the
impact on other pain outcomes (e.g., severity, self-efficacy, use of self-management
strategies), emotional functioning, health-related quality of life, and treatment
satisfaction.
musculoskeletal pain of moderate severity, and randomize them to either the stepped care
intervention or usual care control group. The intervention will be based upon the
empirically-validated Three-Component Model which in SCOPE will involve collaboration
between the primary care physician, a nurse pain care manager, and a supervising physician
pain specialist. SCOPE will involve a telemedicine approach coupling automated home-based
symptom monitoring with telephone-based nurse care management. The intervention will consist
of optimized analgesic management using a stepped care approach to drug selection, symptom
monitoring, dose adjustment, and switching or adding medications. All subjects will undergo
comprehensive outcome assessment at baseline, 1, 3, 6 and 12 months by interviewers blinded
to treatment group. Our principal aim is to test whether SCOPE is more effective than usual
care in reducing pain as measured by the Brief Pain Inventory. Secondarily, we will test the
impact on other pain outcomes (e.g., severity, self-efficacy, use of self-management
strategies), emotional functioning, health-related quality of life, and treatment
satisfaction.
Inclusion Criteria:
SCOPE will enroll 250 primary care veterans with persistent (3 months or longer)
musculoskeletal pain of moderate severity and randomize them to either the stepped care
intervention or usual care control group.
Exclusion Criteria:
Individuals who:
- have filed a pain-related disability claim in the last 6 months;
- do not speak English;
- have moderately severe cognitive impairment;
- have schizophrenia, bipolar disorder, or other psychosis;
- are actively suicidal;
- have current illicit drug use; or
- have an anticipated life expectancy of less than 12 months.
We found this trial at
1
site
Click here to add this to my saved trials
