The effectiveness of telemedicine in chronic pain management compared with in-person visits: a 23-month...

The COVID-19 pandemic accelerated telemedicine adoption, yet its effectiveness in chronic pain management remains uncertain. This study compared telemedicine and in-person outcomes and identified factors influencing success at a Southeast Asian teaching hospital.

A retrospective review analyzed telemedicine and in-person outpatient department (OPD) visits from January 2022 to November 2023. Successful outcomes were defined by improvement on the Patient Global Impression of Improvement (PGI-I ≤ 3/7) scale, Numerical Rating Scale (NRS) reductions ≥ 2/10, or transitions from moderate/severe (>3/10) to mild pain (≤3/10). Generalized estimating equations and logistic regression identified factors associated with successful outcomes.

A total of 565 patients (1746 visits) were included: 282 patients (728 visits) in the telemedicine group (T-group) and 283 patients (1018 visits) in the OPD-group. The T-group was older (63 ± 13 vs 59 ± 13 years; P = 0.01), had more psychological comorbidities (18.44% vs 8.13%; P < 0.001), and lower baseline pain scores compared with the OPD-group (NRS 4.16 ± 2.6 vs 5.43 ± 2.72; P < 0.001). Patients with cancer were more likely to use OPD than telemedicine services (cancer/noncancer patients: 75/208 vs 34/248; P < 0.001). Success rates were comparable (T-group: 76.95%, OPD-group: 81.98%; odds ratio [OR] 0.77 [0.49-1.11]). Predictors of success in telemedicine included mild baseline pain (OR 5.97 [4.22-8.45]) and higher education (OR 1.87 [1.08-3.20]), while OPD success was linked to mild pain (OR 3.45 [2.37-5.02]) and neuropathic pain (OR 1.50 [1.11-2.03]).

Telemedicine provided comparable outcomes with in-person services for both patients with cancer and noncancer patients, although the baseline imbalances that resulted from the observational study design preclude definitive conclusions regarding comparative effectiveness. Identifying predictors of success may guide clinicians in selecting appropriate care modalities. Randomized trials are needed to confirm these findings.