Stepped Care to Optimize Pain Care Effectiveness
This trial is active, not recruiting.
|Sponsor||Department of Veterans Affairs|
|Start date||October 2009|
|End date||June 2013|
|Trial size||250 participants|
|Trial identifier||NCT00926588, IIR 07-119|
Pain is the most common physical symptom in primary care, accounting for an enormous burden in terms of patient suffering, quality of life, work and social disability, and health care and societal costs. Pain is particularly prevalent among veterans. Four major barriers to optimal care include underdetection of pain, inadequate initial treatment, failure to monitor adherence and symptom response, and failure to adjust treatment in patients not responding or intolerant of initial therapy. Therefore, we propose to conduct the Stepped Care to Optimize Pain care Effectiveness (SCOPE) study, a randomized clinical effectiveness trial in primary care.
|Endpoint classification||efficacy study|
|Intervention model||parallel assignment|
Brief Pain Inventory (pain)
time frame: 1 year
Male or female participants from 18 years up to 65 years old.
Inclusion Criteria: SCOPE will enroll 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity and randomize them to either the stepped care intervention or usual care control group. Exclusion Criteria: Individuals who: - have filed a pain-related disability claim in the last 6 months; - do not speak English; - have moderately severe cognitive impairment; - have schizophrenia, bipolar disorder, or other psychosis; - are actively suicidal; - have current illicit drug use; or - have an anticipated life expectancy of less than 12 months.
|Official title||Stepped Care to Optimize Pain Care Effectiveness (SCOPE)|
|Principal investigator||Kurt Kroenke, MD|
|Description||SCOPE will enroll 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity, and randomize them to either the stepped care intervention or usual care control group. The intervention will be based upon the empirically-validated Three-Component Model which in SCOPE will involve collaboration between the primary care physician, a nurse pain care manager, and a supervising physician pain specialist. SCOPE will involve a telemedicine approach coupling automated home-based symptom monitoring with telephone-based nurse care management. The intervention will consist of optimized analgesic management using a stepped care approach to drug selection, symptom monitoring, dose adjustment, and switching or adding medications. All subjects will undergo comprehensive outcome assessment at baseline, 1, 3, 6 and 12 months by interviewers blinded to treatment group. Our principal aim is to test whether SCOPE is more effective than usual care in reducing pain as measured by the Brief Pain Inventory. Secondarily, we will test the impact on other pain outcomes (e.g., severity, self-efficacy, use of self-management strategies), emotional functioning, health-related quality of life, and treatment satisfaction.|
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