As a background, it is well documented that pain is the most common physical symptom for which adults seek medical attention in the United States. Moreover, anxiety and depression are the most common mental health issues for which adults visit a doctor. We also now understand that medications, especially opioids for pain, may not be the only or best therapy.
In the new study, Regenstrief Institute research scientist Kurt Kroenke, M.D., a pioneer in the treatment of patient symptoms, discovered online symptom self-management or online symptom self-management plus clinician telecare can be effective solutions for individuals with anxiety, depression and pain.
“Pain, anxiety and depression 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,” said Dr. Kroenke.
“So treating not just pain, but pain and mood symptoms simultaneously is quite important, as is doing it how, when and where the patient is most receptive.”
In the study, published in the Journal of General Internal Medicine, Dr. Kroenke and colleagues discovered that online symptom self-management works to decrease pain, anxiety and depression symptoms. They also found that online symptom self-management works even better when coupled with clinician telecare.
Prior studies have found a benefit to adding telecare to usual care in the doctor’s office. The researchers have now shown that the intermediate (and less costly) mechanism of online pain and mood self-management is effective and, for some, even more effective when coupled with live phone follow-up with a nurse.
“The magnitude of effect on pain, anxiety and depression we report is comparable to the effect of online and telecare interventions for chronic disorders like hypertension, diabetes and heart disease,” said Dr. Kroenke.
“The moderate improvement in symptoms we saw at a group level indicates that some individuals had great symptom improvement while others had little improvement.
Our results strongly suggest that web-based self-management might be enough for some patients while others may require a combination of online self-management and phone consultations with a nurse manager in order to experience symptom reduction.”
To test whether pain, anxiety and depression symptoms could be simultaneously addressed by patients in their homes or other location of their choice, Dr. Kroenke and colleagues conducted the CAMMPS (Comprehensive vs. Assisted Management of Mood and Pain Symptoms) trial.
This randomized comparative effectiveness study builds upon previous research, including the design of widely used depression and anxiety screening tools, and the conduct of several studies demonstrating the effectiveness of telecare.
For the study, a total of 294 individuals with arm, leg, back, neck or widespread pain which persisted (for 10 or more years in more than half of participants) despite medication, who also had at least moderately severe depression and anxiety, were divided into two groups.
One group received a web-based self-management program comprised of nine modules (coping with pain; pain medications; communicating with providers; depression; anxiety; sleep; anger management; cognitive strategies; and problem-solving).
The other group was given this program plus telecare by a nurse who made scheduled telephone calls as well as contacts prompted by patient responses to the online self-management program or e-mail requests.
A supplementary paper, published in the journal Telemedicine and Telecare, reports that participants in both arms of the study found it helpful and were satisfied. They also discovered higher satisfaction in the group that received both online self-management and telecare.
While those in the online self-management group indicated they wanted more human contact, participants in the group that received telecare from a nurse were divided — some wanted more contact, others desired less contact.
This finding led the paper’s authors, including first author Michael A. Bushey, M.D., of the Indiana School of Medicine and senior author Dr. Kroenke, to conclude that customizable solutions would best suit a range of patients.
Source: Regenstrief Institute