Collaborative Tele-Pain and Substance Use Disorder Care for Patients in a Rural Setting: Results of a Single-Arm Open-Label Pilot Trial

Abstract

Purpose

Little is known about the use of collaborative care models for patients with co-occurring chronic pain and substance use disorders (SUD). This study aimed to pilot test a collaborative care intervention delivered over telehealth to rural patients engaged with SUD treatment who experienced chronic pain.

Design

Single-arm, open-label pilot intervention trial.

Methods

Patients (N=88) were enrolled in SUD treatment at a single VA Medical Center and endorsed moderate-to-severe chronic pain. Patients received a nurse-led collaborative care intervention consisting of a comprehensive pain assessment, up to six follow-up appointments with the nurse care manager (NCM), and an optional 10-session pain education class. All patient encounters occurred remotely via telehealth. Baseline, 1- and 4-month follow up assessments measured outcomes of pain, depression, and substance use. Generalized estimating equations and intent-to-treat procedures modelled changes in outcomes over time.

Results

Patients were predominantly male (85%) and white (85%), with high mental health and substance use disorder comorbidities (92%). The most common substances of use at treatment initiation were alcohol (49%), opioids (17%), cannabis (17%), methamphetamine (11%), and cocaine (6%). By 4-month follow-up, patients who received the pain intervention endorsed significant reductions in pain intensity, pain interference, and depressive symptoms. Among patients using alcohol or cannabis at baseline, significant reductions in days using these substances were also observed.

Conclusions and Clinical Implications

An NCM-led collaborative care intervention delivered via telehealth may improve both pain and substance use outcomes for rural patients with these comorbidities. Large-scale clinical trials are needed to demonstrate intervention efficacy.