Collaborative care for chronic pain in primary care: a cluster randomized trial

Area of Science:

• Health Services Research
• Primary Care Medicine
• Pain Management

Background:

• Chronic pain is a prevalent condition in primary care, often co-occurring with psychological distress and functional disability.
• High healthcare utilization is associated with chronic pain patients.

Purpose of the Study:

• To evaluate the effectiveness of a collaborative care intervention for improving chronic pain-related outcomes.
• To assess the intervention's impact on comorbid depression severity within a Department of Veterans Affairs primary care setting.

Main Methods:

• A cluster randomized controlled trial was conducted across 5 primary care clinics.
• The intervention involved clinician education, patient assessment, activation, symptom monitoring, and facilitated specialty care.
• 401 patients with chronic musculoskeletal pain and disability were randomized, alongside 42 clinicians.

Main Results:

• Intervention patients experienced greater improvements in pain-related disability and pain intensity compared to the usual care group.
• A statistically significant reduction in depression severity was observed in intervention patients with baseline depression (PHQ-9 score ≥ 10).
• Specific outcome measure changes included -1.4 vs -0.2 for Roland-Morris Disability Questionnaire, -4.7 vs -0.6 for CPG Pain Intensity, and -3.7 vs -1.2 for PHQ-9.

Conclusions:

• The collaborative care intervention, "Assistance with Pain Treatment," yielded modest yet statistically significant improvements in pain, disability, and depression.
• This model demonstrates potential for enhancing chronic pain management in primary care settings.