Rationale, design, and baseline findings from a randomized trial of collaborative care for chronic musculoskeletal pain in primary care.
OBJECTIVE
This article describes the rationale, design, and baseline findings from an ongoing study of collaborative care for chronic musculoskeletal pain and comorbid depression.


METHODS
Cluster randomized clinical trial.


METHODS
Forty-two clinicians and 401 patients from five Veterans Affairs primary care clinics.


METHODS
The intervention was based on the chronic care model, and included patient and provider activation and education, patient assessment, outcomes monitoring, and feedback to providers over 12 months. The intervention team consisted of a full-time psychologist care manager and a part-time physician internist. Approaches included goal setting emphasizing function, patient activation and educating about fear avoidance, and care management.


METHODS
Main outcomes are Roland-Morris Disability Questionnaire (RMDQ) score, depression severity (Patient Health Questionnaire-9), and pain severity (Chronic Pain Grade Severity subscale) at 6 and 12 months.


RESULTS
Fifteen percent of primary care patients mailed a study advertisement letter requested screening for the study. The mean age of enrolled patients was 62. Back and neck or joint pain diagnoses were present in 67% and 65% of patients, respectively. Mean pain duration was 15 years, and mean RMDQ score (range 0-24) was 14.7 (standard deviation = 4.4). Sixty-five percent of patients were receiving disability. Eighteen percent of patients met criteria for major depression, 17% for posttraumatic stress disorder, and 9% for alcohol misuse. Thirty-nine percent of patients felt strongly that experiencing pain was a sign of damage, and 60% reported strong avoidance of painful activities.


CONCLUSIONS
These baseline data support the rationale to develop a multifaceted approach to treat chronic pain in primary care that includes detection and treatment of psychiatric comorbidity.
Dobscha
Steven K
SK
Columbia Center for Study of Chronic, Comorbid Physical and Mental Disorders, Portland VA Medical Center, Portland, Oregon 97207, USA. steven.dobscha@va.gov
Corson
Kathryn
K
Leibowitz
Ruth Q
RQ
Sullivan
Mark D
MD
Gerrity
Martha S
MS
D000368:Aged; D015897:Comorbidity; D003299:Cooperative Behavior; D003863:Depression / Q000503:physiopathology; D019468:Disease Management; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000503:physiopathology / Q000628:therapy; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement; D010348:Patient Care Team; D010353:Patient Education as Topic; D011320:Primary Health Care; D011787:Quality of Health Care; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome