The COPE Program: Treatment Efficacy and Medical Utilization Outcome of a Chronic Pain Management Program at a Major Military Hospital

Abstract

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.

Care Management for Persistent Pain: An Introduction

“…13 More individuals present in medical settings with non-malignant pain problems than with any other condition. 16 Individuals with CNMP visit a healthcare practitioner 10.1 times in a 6-month period-as compared with 1.9 times for individuals without pain. 17 Of those aged 20-64 in the United States, 26 million have chronic back pain.…”

“…15 With the exception of the case of individuals suffering from arthritis, however, persistent pain is not often associated with a demonstrable disease. 16 This, along with an absence of adequate education on the part of healthcare consumers and providers and an absence of standards and guidelines for care, makes reliable identification and treatment of persistent pain difficult. 9,21 In consequence, care management strategies used to identify and screen potential populations and then implement individualized treatment plans have great potential for addressing the needs of this underserved population.…”

“…23 Individuals suffering from persistent pain also have an increased usage of healthcare provider services, including emergency department visits and inpatient stays. 16 Workers' compensation systems on both the state and the private level are affected by the high rates of disability associated with persistent pain. 2 In total, the annual costs associated with persistent pain exceed even those related to many major, financially burdensome, conditions.…”

“…Another study of a multidisciplinary pain program conducted in a military hospital setting found a significant drop in the number of clinic visits for participants of the program after the first 3 months of treatment, though this study had no control group. 16 Despite these encouraging findings, multidisciplinary programs remain out of the reach of many patients because the treatment is too expensive or programs are not covered by their health insurance. 34 Additionally, such programs are unavailable to a significant proportion of persistent pain sufferers because their condition remains undiagnosed.…”

Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims

“…Similarly, a recent study of the clinical, medical utilization and cost outcomes associated with including psychological treatment in a multidisciplinary approach to pain treatment found an 87% reduction in outpatient clinic visits in the first 3 months after treatment, resulting in a projected net annual savings of $78,960 in the first year alone. Psychological components were also associated with greater consumer satisfaction (Peters et al 2000).…”