The combined online self-management of pain, anxiety and depression works

Pain is the most common physical symptom for which adults seek medical care in the United States, while anxiety and depression are the most common mental health symptoms for which adults consult a doctor . Drugs, especially opioids, may not be the only treatment or the best treatment.

Highlighting another potential treatment option, a new study by MD researcher Kurt Kroenke, one of the pioneers in the treatment of patient symptoms, has shown that online self-management of symptoms and taking in charge online medical care can be effective. in people with all three symptoms, which occur frequently in this difficult-to-treat patient population.

"Pain, anxiety and depression can create a vicious circle in which the presence of a symptom, if left untreated, can negatively affect the response to treatment of the other two symptoms" said Dr. Kroenke. "So, not only treating pain but also pain and mood symptoms is very important, just as knowing how, when and where the patient is most receptive."

In a new article published in the Journal of General Internal MedicineDr. Kroenke and colleagues reported that online symptom management reduced the symptoms of pain, anxiety, and depression. They also found that self-management of online symptoms worked even better when it was badociated with telemonitoring clinicians. In previous studies, Dr. Kroenke and colleagues have found the benefit of adding phone support to normal physician care. Researchers have now shown that the intermediate (and less expensive) mechanism for managing pain and mood online is effective and, for some, even more effective when it is badociated with telephone follow-up. live with a nurse.

"The importance of the effect on the pain, anxiety and depression we report is comparable to the effect of online and telehomecare interventions for chronic diseases such as diabetes." 39, hypertension, diabetes and heart disease, "said Dr. Kroenke. "The moderate improvement in symptoms seen at the group level indicates that some people showed a significant improvement in their symptoms while others did not improve it much. a web – based self – management might be enough for some patients, while others may require a combination of: online self – management and telephone consultations with a nurse manager in order to experience a reduction symptoms. "

In order to test whether patients could simultaneously treat the symptoms of pain, anxiety and depression at home or in the place of their choice, Dr. Kroenke and his colleagues conducted the study. CAMMPS trial (abbreviation for Comprehensive vs. Assisted Management of Mood & Pain Symptoms). This comparative randomized efficacy study builds on Dr. Kroenke's earlier work, including the development of widely used screening tools for depression and anxiety, and the conduct of several studies. demonstrating the effectiveness of telecare.

A total of 294 people with generalized arm, leg, back, neck or generalized and persistent pain (for at least 10 years in more than half of CAMMPS participants) despite taking medication, also with depression and at least moderately severe anxiety, were divided in two. groups.

One group received a nine-module web-based self-management program (pain management, pain medication, communication with service providers, depression, anxiety, sleep, anger management, cognitive strategies, and problem solving). ). The other group received this program and telemonitoring from a nurse who made regular phone calls as well as contacts solicited by patient responses to the online self-management program or e-mail requests.

An additional article, published in the journal Telemedicine and Telecare, indicates that CAMMPS participants in both parts of the study found it useful and were satisfied – with greater satisfaction from the group receiving both self-management online and telecare. The members of the online self-management group indicated that they wanted more human contact, but the group members who received the nurse's helpline were divided: some wanted more contact, more information, and more. Others, less. This led the authors of the paper, including scientist Michael U Bushey, MD, affiliated with the Regenstrief Institute of the IU School of Medicine, and veteran author, Dr. Kroenke, to conclude that customizable solutions would work best to a range of patients.

"Automated Self Management (ASM) or Enhanced Collaborative Care for Chronic Pain and Mood Symptoms: Randomized Clinical Trial of CAMMPS" Journal of General Internal MedicineAuthors of Dr. Kroenke are Fitsum Baye, MS, and Spencer G Lourens, Ph.D., UI School of Medicine; Erica Evans; Sharon Weitlauf, R.N., Stephanie McCalley and Brian Porter, B.S., of the VA Health Services Research and Development Center for Health Information and Communication, VA Roudebush Medical Center; and investigators from the Regenstrief Institute and VA, Marianne S. Matthias, Ph.D., and Matthew J. Bair, MD Dr. Matthias is also a faculty member of the School of Liberal Arts of IUPUI and Dr. Bair is a faculty member of the IU School of Medicine.

"Management of care of pain and mood symptoms by telebadistance: adherence, usefulness and patient satisfaction" Telemedicine and authors of remote surveillance, in addition to MM. Bushey and Kroenke, are Julia Weiner, former Regenstrief Institute summer researcher, Brian Porter, Erica Evans and Sharon Weitlauf of the VA Medical Center; and Fitsum Baye and Spencer Lourens of the Richard M. Fairbanks School of Public Health of IUPUI.

The CAMMPS trial was funded by a Merit Review for Health Services Research and Development of the Department of Veterans Affairs and badigned to Dr. Kroenke (IIR 12-095).