Nurse-led Tele-Collaborative Pain Care for Rural Patients with Substance Use Disorder

Abstract

PurposeRates of chronic non-cancer pain in patients with substance use disorders (SUD) are higher than in patients without SUD. Yet access to evidence-based pain treatment for patients with SUD is limited, particularly in rural areas where care access is often poor. The purpose of this study was to examine feasibility and preliminary efficacy of a nurse-led collaborative pain intervention for patients with comorbid chronic pain and SUD, delivered exclusively via telehealth. MethodsSubjects were 62 patients with chronic musculoskeletal pain enrolled in specialty SUD treatment at a single VA medical center and residing in rural geographic regions. Subjects received an initial pain assessment and treatment recommendations, 6 follow-up appointments over four months, and a 10-session weekly pain education class. All clinical encounters were delivered via video conference or telephone, based on patient preference and internet availability. Subjects completed an interviewer administered survey at baseline, 1- and 4-month follow-up that assessed pain severity and interference as measured by the Brief Pain Inventory, depression symptoms as measured by the Beck Depression Inventory-II, and daily substance use outcomes as measured by the Timeline Followback. ResultsPatients on average were 48 years old, and the majority were male (86%) and White Non-Hispanic (91%). By 4-month follow-up, pain severity (B = -0.67 [-1.05, -0.29]), pain interference (B = -0.94 [-1.50, -0.39]), and depression symptoms (B = -4.30 [-7.96, -0.63]) had significantly declined from baseline. A significant reduction in days of alcohol (OR = 0.64 [0.46, 0.90]) and cannabis use (OR = 0.47 [0.34, 0.66]) was also observed at 4-month follow-up. ConclusionPreliminary analyses show promise for synchronous telehealth collaborative pain interventions delivered to rural patients receiving SUD treatment, with particular benefit in reducing pain, depression symptoms, and alcohol and cannabis use.