Collaborative Care for Chronic Pain in Primary Care

Dobscha, Steven K.; Corson, Kathryn; Perrin, Nancy; Hanson, Ginger C.; Leibowitz, Ruth Q.; Doak, Melanie N.; Dickinson, Kathryn; Sullivan, Mark D.; Gerrity, Martha S.

doi:10.1001/jama.2009.377

Cited by 294 publications

(293 citation statements)

References 56 publications

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“…Study design, participant inclusion, and main results have been reported in detail elsewhere [31][32]. The study took place in three urban and two rural primary care clinics of a VA medical center in the Pacific Northwest.…”

Section: Methodsmentioning

confidence: 99%

Complementary and alternative medicine use among veterans with chronic noncancer pain

Denneson

Corson

Dobscha³

2011

JRRD

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Abstract-We describe prior use and willingness to try complementary and alternative medicine (CAM) among 401 veterans experiencing chronic noncancer pain and explore differences between CAM users and nonusers. Participants in a randomized controlled trial of a collaborative intervention for chronic pain from five Department of Veterans Affairs (VA) primary care clinics self-reported prior use and willingness to try chiropractic care, massage therapy, herbal medicines, and acupuncture. Prior CAM users were compared with nonusers on demographic characteristics, pain-related clinical characteristics, disease burden, and treatment satisfaction. A majority of veterans (n = 327, 82%) reported prior use of at least one CAM modality, and nearly all (n = 399, 99%) were willing to try CAM treatment for pain. Chiropractic care was the least preferred option, whereas massage therapy was the most preferred (75% and 96%, respectively). CAM users were less likely to have service-connection disabilities (54% vs 68%; chi square = 4.64, p = 0.03) and reported having spent a larger percentage of their lives in pain (26% vs 20%; Z = 1.40, p = 0.04) than nonusers. We detected few differences between veterans who had tried CAM and those who had not, suggesting that CAM may have broad appeal among veterans with chronic pain. Implications for VA policy and practice and for clinicians treating veterans with chronic pain are discussed.Clinical Trial Registration: ClinicalTrials.gov. NCT00129480, "Improving the Treatment of Chronic Pain in Primary Care"; http://www.clinicaltrials.gov.

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Section: Methodsmentioning

confidence: 99%

Complementary and alternative medicine use among veterans with chronic noncancer pain

Denneson

Corson

Dobscha³

2011

JRRD

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“…As part of the safety assessment, appropriate opioid prescribing should include consideration of potential interactions with coprescribed medications, including other controlled substances such as benzodiazepines, alcohol, and illicit substances. With respect to enhancing efficacy, consensus guidelines and a growing body of evidence 8,9 support multi-modal pain treatment. Opioid therapy is optimal when provided along with education to promote patient self-efficacy and self-care, and evidence-based psychological and rehabilitation therapies.…”

Section: Characterizing Appropriate Ongoing Opioid Prescribing: Shiftmentioning

confidence: 99%

A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care

et al. 2013

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The challenges facing patients and providers in managing ongoing opioid analgesic therapy for chronic pain are complex. Benefit of long-term opioid therapy, for which there are scant data, must be balanced against myriad potential undesired outcomes, including safety problems, ranging from mild toxicities to overdose and death; inadequate efficacy, which may mean continued patient suffering and unwarranted exposure to toxicities; and misuse of these potent medications. To help patients and providers navigate these challenges and optimize therapy, we present a research agenda in which we first characterize appropriate ongoing opioid prescribing and then describe three areas where quality improvement work is needed: 1) developing brief validated measures of patient-reported safety, efficacy, and misuse that improve outcomes; 2) designing evidence-based algorithms to guide changes in therapy when issues related to safety, efficacy or misuse are identified; and 3) promoting use of patientcentered, multi-modal treatment plans.KEY WORDS: opioid analgesics; medication safety; provider behavior; quality of care.

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“…Collaborative care has also been shown to be efficacious in reducing pain severity and painrelated disability and depression among chronic patients. 12 The foreseeable effects of collaborative care management in primary care are substantial: collaborative care has the potential to reduce the global burden of depression-related illness overall, as well as improve population-level well-being. 5 But to reap the optimal benefits from this type of arrangement, it is critical that the primary care and mental health care cultures-using a common treatment approach-integrate over time.…”

Section: Introductionmentioning

confidence: 99%

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

Tai–Seale

Kunik

Shepherd³

et al. 2010

Population Health Management

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Primary care remains critically important for those who suffer from mental disorders. Although collaborative care, which integrates mental health services into primary care, has been shown to be more effective than usual care, its implementation has been slow and the experience of providers and patients with collaborative care is less well known. The objective of this case study was to examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters.Participating physicians completed a self-administered visit reconstruction questionnaire in which they logged details of patient visits and described their perceptions of the visits and the influence of collaborative care. Audio recordings of visits were analyzed to assess the extent of discussion about colocated mental health services and visit time devoted to mental health topics.The main outcome measures were the extent of discussion and recommendation for collaborative care during clinical visits and providers' experiences based on their responses to the visit reconstruction questionnaire. Providers surveyed expressed enthusiasm about collaborative care and cited the time constraint of office visits and lack of specialty support as the main reasons for limiting their discussion of mental health topics with patients.

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Collaborative Care for Chronic Pain in Primary Care

Cited by 294 publications

References 56 publications

Complementary and alternative medicine use among veterans with chronic noncancer pain

Complementary and alternative medicine use among veterans with chronic noncancer pain

A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

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