Emma Johnson, BS
Assistant Clinical Research Coordinator
The University of North Carolina at Chapel Hill
Raleigh, North Carolina
Lindsay Stewart, BA
Clinical Research Coordinator
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Kevin Musgrow, B.S
Assistant Clinical Research Coordinator
University of North Carolina at Chapel Hill School of Medicine - Chapel Hill, NC
Chapel Hill, North Carolina
We evaluated a multicomponent intervention to improve pain recovery in older adults with acute MSP in emergency department (ED) or urgent care (UC) settings.
Methods: We randomized English-speaking ED or UC patients ≥50 years old, presenting with acute MSP (baseline pain intensity ≥4) to either: 1) usual care, 2) interactive educational video, or 3) interactive educational video, nurse telecare at 48-72 hours, and primary care provider message. Patients using daily opioids for >2 weeks prior to an ED or UC visit were excluded. Our primary outcome was the Brief Pain Inventory (BPI), an 11-item self-reported pain interference and intensity score over the past week ranging from 0 (no interference/pain) to 10 (completely interferes/worst pain). A 1-point difference is considered clinically significant. We compared BPI at 1, 3, and 6 months across arms using a linear mixed model adjusting for setting (ED or UC), baseline pain intensity, opioid use, age, sex, race, comorbidity score, chronic pain history, and primary care provider access. Secondary analyses included pairwise contrasts.
Results:
Participants (n=330) had a mean age of 64.7 years; 68.5% were female, 73.3% were White, and 66.3% had a college education. Baseline mean pain intensity was 5.1 and was similar across arms. At 6 months, mean (SD) BPI was 2.84 (2.41) for usual care, 2.35 (2.46) for video, and 2.22 (2.21) for full intervention. The primary outcome comparing BPI among the three arms across all time points was not significant (p=0.13). At 6 months, mean BPI differences were -0.55 (95% CI: -1.14, 0.04; p=0.07) between video intervention and usual care, and -0.58 (95% CI: -1.17, 0.00; p=0.05) between full intervention and usual care. In a post-hoc comparison of either the video or full intervention vs. usual care, BPI at 6 months was reduced by 0.57 (95% CI: -0.06, -1.07; nominal p=0.03).
Conclusions/Implications for future research and/or clinical care:
The trial results did not show an effect on the primary outcome of pain interference and intensity through 6 months. A post hoc analysis of the pooled effect of either intervention vs. usual care suggests lower pain and pain interference through 6 months. Further research is needed to confirm the value of early patient education to reduce the transition from acute to chronic MSP.