Development and implementation of a telehealth-enhanced intervention for pain and symptom management

Abstract

Managing chronic pain effectively is often challenging for health care providers and patients. Telehealth technologies can bridge geographic distance and improve patients' quality of care in communities where access to pain specialists has previously been unavailable. This paper describes the development and evaluation of a telehealth intervention (TelePain) designed to address the need for pain specialist consultation regarding pain and symptom management issues in non-academic medical centers. We describe the theoretical foundation and development of a multifaceted intervention using a cluster randomized clinical trial design. Health care providers and their patients with chronic pain are enrolled in the study. Patient participants receive the intervention (report of symptoms and receipt of a pain graph) weekly for 8 weeks and are contacted at 12 weeks for completion of post-intervention follow-up measures. Their providers attend Telepain sessions which involve a didactic presentation on an evidence-based topic related to pain management followed by patient case presentations and discussion by community clinicians. Symptom management recommendations for each patient case are made by a panel of pain specialists representing internal medicine, addiction medicine, rehabilitation medicine, anesthesiology, psychiatry, and nursing. The outcomes assessed in this randomized trial focus on pain intensity, pain's interference on function and sleep, and anxiety, depression, and cost-effectiveness. Some of the challenges and lessons that we have learned early in implementing the TelePain intervention are also reported.

Mobile Phone Interventions for Sleep Disorders and Sleep Quality: Systematic Review

“…All 39 remaining articles were then downloaded as PDF files for full-text peer review and discussion [ 13 - 16 , 21 , 22 , 38 - 70 ]. We excluded 23 articles after the full-text screening for the following reasons: (1) a device or program feasibility study (n=2) [ 66 , 69 ], (2) duplicated article (n=1) [ 21 ], (3) not an intervention study (n=5) [ 39 , 43 , 47 , 49 , 53 ], (4) not a mobile phone intervention (n=7) [ 14 , 42 , 48 , 56 , 58 , 63 , 68 ], (5) no sleep outcome (n=3) [ 16 , 44 , 65 ], and (6) a protocol or trial (n=5) [ 40 , 45 , 50 - 52 ]. The entire selection procedure was independently performed by two researchers (JCS and JK), and then the research team resolved differences by discussion.…”

TelePain: A Community of Practice for Pain Management

“…This has the potential to translate into an increased rate of successful treatments of future patients, not only those treated by CoP members, but others treated in their clinic. A study is currently underway to test the effectiveness of TelePain on patient outcomes [18]. …”

Transitions of Care for Postoperative Opioid Prescribing in Previously Opioid-Naïve Patients in the USA: a Retrospective Review

“…Geographic barriers, underinsurance, and referral practices limit access to pain specialists. 20,21 Among opioid-naïve patients with new persistent use, we found that utilization of PM&R/Pain Medicine for opioid prescriptions varied among geographic regions. Also seen in Table 1, PM&R/Pain Medicine physicians were more likely to prescribe opioids following minor surgeries to older patients that have an education level of at least a bachelor degree, increased comorbidities, and pain disorders.…”