Collaborative Care to Treat Chronic Pain after Traumatic Brain Injury: A Randomized Controlled Trial

Abstract

<h3>Research Objectives</h3> To examine the effectiveness of collaborative care (CC) compared to usual care (UC) to treat chronic pain in individuals with traumatic brain injury (TBI). <h3>Design</h3> Randomized Controlled Trial. <h3>Setting</h3> TBI Rehabilitation Clinics. <h3>Participants</h3> 158 individuals with TBI who were followed in Rehabilitation clinics and endorsed chronic pain. <h3>Interventions</h3> CC included up to 12 visits with a care manager focused on cognitive behavioral treatment (CBT) for pain and coordination with TBI expert group (Psychologist, Physiatrist, Psychiatrist and Neurology Headache Specialist) for medical recommendations. <h3>Main Outcome Measures</h3> Pain Interference as measured by the Brief Pain Inventory (BPI: 0=pain does not interfere to 10=pain completely interferes). <h3>Results</h3> 79 individuals were randomized to each group (CC and UC). 58% were female, injured 4 years ago on average (SD=5.9), 65% had mild TBI, with 19% severe TBI. Of those in CC, 90% completed 11 or 12 sessions. At 4 months post randomization, the CC group had significantly lower pain interference (3.46, SD=2.17) compared to UC (5.03, SD=2.28; p<.001). This difference was maintained at 8 months post randomization (CC=3.61(2.22); UC=4.68(2.51); P=.04). In addition, pain severity (0=no pain, to 10=worst pain) was significantly lower in the CC group at 4 months (3.63, SD=1.95) compared to UC (4.90, SD=2.07). Pain severity was not significantly different at 8 months (p=.07) though lower for both groups (CC=3.51(2.07); UC+4.40(2.27). <h3>Conclusions</h3> Collaborative Care, including CBT for pain and TBI-expert medical recommendations, is a promising approach to reduce pain interference after TBI. Chronic pain is often considered difficult to treat, and implementation of multi-disciplinary CC in Rehabilitation Clinics could benefit patients, providers, and payors as an evidence-based and cost-effective strategy for decreasing disability and increasing function. <h3>Author(s) Disclosures</h3> Authors have no conflicts.