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Stepped-care and collaborative-care models for chronic musculoskeletal pain

July 25, 2018

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Between 2009 and 2015, VA researchers published results from four important clinical trials showing the benefits of stepped-care and collaborative care models for treating chronic musculoskeletal pain. The studies found that VA's stepped-care model of pain management for chronic pain resulted in significant reductions in pain-related disability, pain interference, and pain severity compared with usual care. This approach gives clinicians the ability to assess and treat pain within a primary care setting, while enabling them to use other treatment options, including specialized care and multidisciplinary approaches.

The stepped-care model for pain management (SCM-PM) is designed to integrate with the Patient Aligned Care Team (PACT), providing quality and accessible primary care for Veterans. SCM-PM and PACT help Veterans by ensuring that VA clinicians are fully trained in pain management techniques; ensuring that pain assessment is performed in a consistent manner throughout VA; and placing the Veteran at the center of their health care team, facilitating prompt and appropriate pain treatment. The SCM-PM also stresses the importance of equitable access to health care and the effective use of resources to manage pain for enrolled Veterans.

Findings from the earlier trials were incorporated into the 2009 National Pain Management Directive emphasizing stepped-care models. As a result, VA implemented the stepped-care model as the single standard of pain care. It is now used throughout VA to treat chronic pain.

Selected publications:

Bair MJ, Ang D, Wu J, Outcalt SD, Sargent C, Kempf C, Froman A, Schmid AA, Damush TM, Yu Z, Davis LW, Kroenke K. Evaluation of stepped are for chronic pain (ESCAPE) in Veterans of Iraq and Afghanistan conflicts: A randomized clinical trial. JAMA Intern Med. 2015 May;175(5):682-9.

Dobscha SK, Corson K, Perrin NA, Hanson GC, Leibowitz RQ, Doak MN, Dickinson KC, Sullivan MD, Gerrity MS. Collaborative care for chronic pain in primary care: A cluster randomized trial. JAMA. 2009 Mar 25;301(12):1242-52.

Kroenke K, Bair MJ, Damush TM, Wu J, Hoke S, Sutherland J, Tu W. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: A randomized controlled trial. JAMA. 2009 May 27;301(20):2099-110.

Kroenke K, Krebs EE, Wu J, Yu Z, Chumbler NR, Bair MJ. Telecare collaborative management of chronic pain in primary care: A randomized clinical trial. JAMA. 2014 Jul 16;312(3):240-8.


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