Collaborative-care model reduces TBI pain, study shows

When an integrated-care manager teaches patients cognitive behavioral skills and oversees medications, symptoms improve.

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Pain is among the most difficult and complex chronic conditions to treat. A new study shows that a collaborative-care approach significantly reduced chronic pain symptoms in patients with traumatic brain injury. The approach, the authors say, offers a blueprint for pain management across a variety of injuries.

Researchers found that patients who received the TBI Care intervention developed at the University of Washington School of Medicine experienced less interference from pain for at least eight months after learning pain-management skills and developing a symptom-guided plan with a care manager.

“Pain is a huge problem,” said lead author Jeanne Hoffman, a clinical psychologist and professor of rehabilitation medicine at UW Medicine. “I feel like people with brain injury get the worst of it because they don't remember to always push for the thing that they need, and they just get discouraged. Many people just say, ‘Well, whatever, I guess it's just what I have to live with.’ And their lives get pretty small.”

Patients with traumatic brain injury typically are left to navigate their own rehabilitation care. This means tracking and attending medical and physical therapy appointments, evaluating medications, obtaining prescription alterations and refills, and managing symptoms, such as headaches, whose causes are uncertain.

Collaborative care introduces a manager to teach coping skills that help mitigate pain. The manager also helps the patient navigate care and medication changes.

The findings appeared June 3 in JAMA Network Open. A team of researchers from the UW Medicine departments of rehabilitation medicine, neurology and psychiatry and behavioral sciences conducted the study.

More than 150 adult participants were randomized into groups that received usual rehabilitation pain care or TBI Care. The group that received the intervention met with a care manager up to 12 times over a 16-week period to receive person-centered cognitive behavioral treatment, including goal setting, managing thoughts and relaxation training. The care manager met weekly with the clinical team to discuss patient care and get recommendations for next steps and potential medication changes.

Members in the coordinated-care group saw significant improvement in pain control at four and eight months and a reduction in depression, anxiety and care dissatisfaction compared with the usual-care group.

“It's hard to get this kind of wraparound care for people. I think that's really what we want to do: Give people what they need, when they need it and how they need it,” Hoffman said. “It's one of those things where it really brings the experts together for better quality healthcare.”

Hoffman and her colleagues suggest that the collaborative-care model holds promise for individuals who receive care in rehabilitation medicine clinics for other conditions, including spinal cord injury, multiple sclerosis, limb loss and nerve injury. 

“We saw such great results with this one, we spent almost a year trying to figure out how to bring it into the real world. It's the kind of care that people should get, and our hope is we can justify getting this out into every rehab clinic, and, honestly, every clinic everywhere.”

The trial was funded as part of the University of Washington Traumatic Brain Injury Model System and by a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (90DPTB0008).

The authors’ conflict-of-interest statements are in the published paper, which will be provided to journalists upon request.


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Tags:traumatic brain injurypainrehabilitation medicine

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