title: Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial study design and sample characteristics.
abstract: 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. Although collaborative care interventions are well-established for conditions such as depression, fewer systems-based interventions have been tested for chronic pain. This paper describes the study design and baseline characteristics of the enrolled sample for the Stepped Care to Optimize Pain care Effectiveness (SCOPE) study, a randomized clinical effectiveness trial conducted in five primary care clinics. SCOPE has enrolled 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity and randomized them to either the stepped care intervention or usual care control group. Using a telemedicine collaborative care approach, the intervention couples automated symptom monitoring with a telephone-based, nurse care manager/physician pain specialist team to treat pain. The goal is to optimize analgesic management using a stepped care approach to drug selection, symptom monitoring, dose adjustment, and switching or adding medications. All subjects undergo comprehensive outcome assessments at baseline, 1, 3, 6 and 12 months by interviewers blinded to treatment group. The primary outcome is pain severity/disability, and secondary outcomes include pain beliefs and behaviors, psychological functioning, health-related quality of life and treatment satisfaction. Innovations of SCOPE include optimized analgesic management (including a stepped care approach, opioid risk stratification, and criteria-based medication adjustment), automated monitoring, and centralized care management that can cover multiple primary care practices.
authors.affiliation: VA HSR&D Center for Implementing Evidence-Based Practice, Roudebush VA Medical Center, Indianapolis, IN, USA. kkroenke@regenstrief.org
authors.forename: Kurt
authors.initials: K
authors.lastname: Kroenke
authors.forename: Erin
authors.initials: E
authors.lastname: Krebs
authors.forename: Jingwei
authors.initials: J
authors.lastname: Wu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
authors.forename: Teresa
authors.initials: T
authors.lastname: Damush
authors.forename: Neale
authors.initials: N
authors.lastname: Chumbler
authors.forename: Tish
authors.initials: T
authors.lastname: York
authors.forename: Sharon
authors.initials: S
authors.lastname: Weitlauf
authors.forename: Stephanie
authors.initials: S
authors.lastname: McCalley
authors.forename: Erica
authors.initials: E
authors.lastname: Evans
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Barnd
authors.forename: Zhangsheng
authors.initials: Z
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000554:Ambulatory Care Facilities; D000700:Analgesics / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health
chemical_list: D000700:Analgesics