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Telehealth interventions improve symptoms with chronic pain and anxiety, depression
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Telehealth interventions delivered online, over the phone and with and without clinician interaction improved outcomes in patients with chronic musculoskeletal pain in addition to depression and/or anxiety, according to study results recently published in the Journal of General Internal Medicine.
“Musculoskeletal pain, depressive, and anxiety disorders ... account for [six] of the [nine] leading causes of disability in the USA,” Kurt Kroenke, MD, of the VA HSR&D Center for Health Information and Communication at the Roudebush VA Medical Center, the department of medicine at Indiana University School of Medicine and Regenstrief Institute Inc., and colleagues wrote. “Pain-anxiety-depression (PAD) can produce a vicious cycle in which the presence of one symptom, if untreated, may negatively affect the response to treatment of the other two symptoms.”
Researchers of the Comprehensive vs. Assisted Management of Mood and Pain Symptoms (CAMMPS) study compared two types of telehealth interventions to determine the effect each had on patients with PAD. Participants in the trial were enrolled at one of six primary care clinics at Veterans Affairs medical center between January 2014 and June 2016.
Those included in the study were randomized to receive automated self-management (ASM) alone or ASM combined with comprehensive symptom management (CSM). Both groups received automated system monitoring and were asked to complete pain and mood self-management modules on the phone over the course of the study period.
The CSM group received ASM and collaborative care management through a nurse-physician team that met each week to evaluate patient care. Survey responses that indicated nonadherence or side effects to medication, request for treatment change, a call from a nurse, or missed reports resulted in email alerts sent to a nurse. In addition to responding to email alerts, nurses corresponded with patients through scheduled calls.
A total of 294 people were included in the study, with 147 assigned to receive ASM and 147 assigned to receive CSM. Among participants, 55.1% had probable major depression and 55.4% had probably PTSD. Prior to the study, 57.1% of participants reported pain duration of more than 10 years.
After 12 months, PAD symptoms improved in both groups, particularly in the CSM group. Compared with the ASM group, CSM patients were more likely to report being much more improved (26.8% vs. 39.5%) and were less likely to report worsened symptoms (35.8% vs. 19.4%).
The overall proportion of patients who received opioids decreased from 21.4% at baseline to 17% after 12 months, with similar rates in both treatment groups.
“CAMMPS shows that an automated treatment approach (ASM) can be safely used but that CSM, with added human interaction through collaborative care, was comparatively more effective,” Kroenke and colleagues wrote. “Given these findings, one could opt for sequential administration, with web-based self-management and monitoring (ASM) initially followed by the more resource-intensive CSM for patients not responding.” – by Erin Michael
Disclosures: The authors report no relevant financial disclosures.