Collaborative care for pain results in both symptom improvement and sustained reduction of pain and depression

Stephen Thielke, Kathryn Corson, Steven Dobscha

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: Traditional analytic approaches may oversimplify the mechanisms by which interventions effect change. Transition probability models can quantify both symptom improvement and sustained reduction in symptoms. We sought to quantify transition probabilities between higher and lower states for four outcome variables and to compare two treatment arms with respect to these transitions. Method: Secondary analysis of a year-long collaborative care intervention for chronic musculoskeletal pain in veterans. Forty-two clinicians were randomized to intervention or treatment as usual (TAU), with 401 patients nested within clinician. The outcome variables, pain intensity, pain interference, depression and disability scores were dichotomized (lower/higher). Probabilities of symptom improvement (transitioning from higher to lower) or sustained reduction (remaining lower) were compared between intervention and TAU groups at 0- to 3-, 3- to 6- and 6- to 12-month intervals. General estimating equations quantified the effect of the intervention on transitions. Results: In adjusted models, the intervention group showed about 1.5 times greater odds of both symptom improvement and sustained reduction compared to TAU, for all the outcomes except disability. Conclusions: Despite no formal relapse prevention program, intervention patients were more likely than TAU patients to experience continued relief from depression and pain. Collaborative care interventions may provide benefits beyond just symptom reduction.

Original languageEnglish (US)
Pages (from-to)139-143
Number of pages5
JournalGeneral Hospital Psychiatry
Volume37
Issue number2
DOIs
StatePublished - Mar 1 2015

Fingerprint

Depression
Pain
Therapeutics
Musculoskeletal Pain
Veterans
Secondary Prevention
Chronic Pain

Keywords

  • Collaborative
  • Pain
  • Relapse
  • Remission
  • Transition

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Collaborative care for pain results in both symptom improvement and sustained reduction of pain and depression. / Thielke, Stephen; Corson, Kathryn; Dobscha, Steven.

In: General Hospital Psychiatry, Vol. 37, No. 2, 01.03.2015, p. 139-143.

Research output: Contribution to journalArticle

@article{a5f7ad6fd10f42aea570ba619516fe62,
title = "Collaborative care for pain results in both symptom improvement and sustained reduction of pain and depression",
abstract = "Objective: Traditional analytic approaches may oversimplify the mechanisms by which interventions effect change. Transition probability models can quantify both symptom improvement and sustained reduction in symptoms. We sought to quantify transition probabilities between higher and lower states for four outcome variables and to compare two treatment arms with respect to these transitions. Method: Secondary analysis of a year-long collaborative care intervention for chronic musculoskeletal pain in veterans. Forty-two clinicians were randomized to intervention or treatment as usual (TAU), with 401 patients nested within clinician. The outcome variables, pain intensity, pain interference, depression and disability scores were dichotomized (lower/higher). Probabilities of symptom improvement (transitioning from higher to lower) or sustained reduction (remaining lower) were compared between intervention and TAU groups at 0- to 3-, 3- to 6- and 6- to 12-month intervals. General estimating equations quantified the effect of the intervention on transitions. Results: In adjusted models, the intervention group showed about 1.5 times greater odds of both symptom improvement and sustained reduction compared to TAU, for all the outcomes except disability. Conclusions: Despite no formal relapse prevention program, intervention patients were more likely than TAU patients to experience continued relief from depression and pain. Collaborative care interventions may provide benefits beyond just symptom reduction.",
keywords = "Collaborative, Pain, Relapse, Remission, Transition",
author = "Stephen Thielke and Kathryn Corson and Steven Dobscha",
year = "2015",
month = "3",
day = "1",
doi = "10.1016/j.genhosppsych.2014.11.007",
language = "English (US)",
volume = "37",
pages = "139--143",
journal = "General Hospital Psychiatry",
issn = "0163-8343",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Collaborative care for pain results in both symptom improvement and sustained reduction of pain and depression

AU - Thielke, Stephen

AU - Corson, Kathryn

AU - Dobscha, Steven

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Objective: Traditional analytic approaches may oversimplify the mechanisms by which interventions effect change. Transition probability models can quantify both symptom improvement and sustained reduction in symptoms. We sought to quantify transition probabilities between higher and lower states for four outcome variables and to compare two treatment arms with respect to these transitions. Method: Secondary analysis of a year-long collaborative care intervention for chronic musculoskeletal pain in veterans. Forty-two clinicians were randomized to intervention or treatment as usual (TAU), with 401 patients nested within clinician. The outcome variables, pain intensity, pain interference, depression and disability scores were dichotomized (lower/higher). Probabilities of symptom improvement (transitioning from higher to lower) or sustained reduction (remaining lower) were compared between intervention and TAU groups at 0- to 3-, 3- to 6- and 6- to 12-month intervals. General estimating equations quantified the effect of the intervention on transitions. Results: In adjusted models, the intervention group showed about 1.5 times greater odds of both symptom improvement and sustained reduction compared to TAU, for all the outcomes except disability. Conclusions: Despite no formal relapse prevention program, intervention patients were more likely than TAU patients to experience continued relief from depression and pain. Collaborative care interventions may provide benefits beyond just symptom reduction.

AB - Objective: Traditional analytic approaches may oversimplify the mechanisms by which interventions effect change. Transition probability models can quantify both symptom improvement and sustained reduction in symptoms. We sought to quantify transition probabilities between higher and lower states for four outcome variables and to compare two treatment arms with respect to these transitions. Method: Secondary analysis of a year-long collaborative care intervention for chronic musculoskeletal pain in veterans. Forty-two clinicians were randomized to intervention or treatment as usual (TAU), with 401 patients nested within clinician. The outcome variables, pain intensity, pain interference, depression and disability scores were dichotomized (lower/higher). Probabilities of symptom improvement (transitioning from higher to lower) or sustained reduction (remaining lower) were compared between intervention and TAU groups at 0- to 3-, 3- to 6- and 6- to 12-month intervals. General estimating equations quantified the effect of the intervention on transitions. Results: In adjusted models, the intervention group showed about 1.5 times greater odds of both symptom improvement and sustained reduction compared to TAU, for all the outcomes except disability. Conclusions: Despite no formal relapse prevention program, intervention patients were more likely than TAU patients to experience continued relief from depression and pain. Collaborative care interventions may provide benefits beyond just symptom reduction.

KW - Collaborative

KW - Pain

KW - Relapse

KW - Remission

KW - Transition

UR - http://www.scopus.com/inward/record.url?scp=84924807974&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924807974&partnerID=8YFLogxK

U2 - 10.1016/j.genhosppsych.2014.11.007

DO - 10.1016/j.genhosppsych.2014.11.007

M3 - Article

C2 - 25554014

AN - SCOPUS:84924807974

VL - 37

SP - 139

EP - 143

JO - General Hospital Psychiatry

JF - General Hospital Psychiatry

SN - 0163-8343

IS - 2

ER -