Recent studies, including one from the ASHP Midyear Clinical Meeting, highlight strategies for achieving equitable outcomes in patients with pain.
Numerous sessions at the 2024 Midyear Clinical Meeting and Exhibition of the American Society of Health-System Pharmacists—ASHP Midyear Clinical Meeting—focused on pain management. More than 10 PharmDs participated in these sessions, with content geared primarily toward established clinicians. One session included a track for residents and new clinicians.
Tanya J. Uritsky, PharmD, served as program chair and moderator for one of these sessions alongside faculty member Jessica Geiger, PharmD. The session examined patients with pain presenting in different clinical settings. Dr. Uritsky and Dr. Geiger focused on best practices for pain management in this patient population, citing examples that included a patient presenting with acute pain in the inpatient setting and a patient presenting with pain in the ambulatory care setting. The session also examined the impact of language on stigma and bias among patients presenting with painful conditions.
A study published in the International Journal of Environmental Research and Public Health that was not presented at the meeting focused on a similar topic, pain. Maria Carmela Monaco, MD, and colleagues examined telemedicine as a strategy to improve pain care. Their research highlighted another topic covered by Dr. Uritsky and Dr. Geiger—health disparities—by describing the potential of telemedicine for improving equitable health outcomes.
“Telemedicine represents a potential solution to reduce healthcare disparities and optimize pain management, particularly in contexts where in-person visits are challenging,” Dr. Monaco and colleagues wrote. “The aim of this study is to evaluate the effectiveness of a telemedicine-based intervention in improving pain outcomes and enhancing the QOL of [patients with] pain. The primary hypothesis of this study is that telemedicine interventions will lead to significant improvements in pain management.”
Design of Telemedicine Intervention
This multicenter retrospective assessment included cancer survivors with complex pain (N=100; median age, 65; 62% women). The researchers assessed pain, disability, and self-perceived health status using the Numeric Rating Scale (NRS), the Brief Pain Inventory (BPI), the Oswestry Disability Index (ODI), and the EuroQOL five-dimension five-level (EQ-5D-5L) questionnaire. The most common diagnoses included neuropathic pain (54%) and complex pain (32%).
All treatment and monitoring were completed using the telemedicine intervention for all study participants; the telemedicine platform was specifically designed for remote patient monitoring and management.
The platform had updated video communication systems to facilitate effective interaction between patients and healthcare providers. The platform included the following features:
- Secure patient access with personal credentials for clinicians to ensure data privacy and security;
- Patient data management that enabled the creation of individual patient profiles, with the ability to upload treatment plans and medical histories;
- Two-way communication and mobile app integration that allowed for communication between patients and clinicians via email, plus the ability for patients to use a mobile app to manage telehealth visits, send information, and receive updates; and
- Caregiver access to relevant information on the platform for better patient support.
Telemedicine visits occurred approximately every 10 to 15 days to enable continuous monitoring of patients and allow for timely interventions.
Telemedicine’s Role in Improved Health Outcomes
Dr. Monaco and colleagues reported significant clinical improvements following 6 months of the telemedicine intervention (all P<0.001). Specifically, NRS scores improved by more than four points in 77% of patients, BPI Worst Pain Scores declined by four points in 52% of patients and by five points in 28%. Disability levels among all patients improved from severe (median ODI score, 52) to moderate (median ODI score, 30).
Further, patients’ self-perceived health status improved from 40 to 60 on the EQ-5D-5L. The telemedicine interventions significantly decreased pain intensity and disability levels and improved QOL in patients with pain.
“It is important to clarify that the improvements in pain perception observed in this study were not solely attributable to telemedicine interventions,” the researchers wrote. “Rather, they were part of a multidisciplinary approach that also included pharmacological therapies and interventional treatments. Telemedicine played a critical supportive role by facilitating continuous patient management, providing timely communication, and ensuring patient engagement.”
The findings align with results from previous studies, according to Dr. Monaco and colleagues, who noted that the primary therapeutic role of telemedicine “lies in its capacity to provide an effective connection” between care in the hospital, outpatient centers, and at home.
“Digital healthcare solutions offer personalized and continuous care, focusing on patients’ needs, particularly in remote and underserved areas, to ensure equitable health outcomes,” the study team wrote. “Integrating telemedicine into healthcare approaches is essential for achieving health equality. Further studies should explore the long-term impacts, cost-effectiveness, and scalability of telemedicine interventions for pain management. It is also vital to develop customized healthcare options catering to diverse patient populations.”
