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BMC Health Services Research
Published in: BMC Health Services Research 1/2005

Open Access 01-12-2005 | Research article

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

Authors: Paul R Chelminski, Timothy J Ives, Katherine M Felix, Steven D Prakken, Thomas M Miller, J Stephen Perhac, Robert M Malone, Mary E Bryant, Darren A DeWalt, Michael P Pignone

Published in: BMC Health Services Research | Issue 1/2005

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Abstract

Background

Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial.

Methods

Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse.

Results

Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%).

Conclusions

A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.
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Metadata
Title
A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity
Authors
Paul R Chelminski
Timothy J Ives
Katherine M Felix
Steven D Prakken
Thomas M Miller
J Stephen Perhac
Robert M Malone
Mary E Bryant
Darren A DeWalt
Michael P Pignone
Publication date
01-12-2005
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2005
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-5-3

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