Stepped Care to Optimize Pain Care Effectiveness (SCOPE) trial: study design and sample characteristics
Abstract
Pain is the most common physical symptom in primary care, accounting for an enormous burden in terms of patient suffering, quality of life, work and social disability, and health care and societal costs. Although collaborative care interventions are well-established for conditions such as depression, fewer systems-based interventions have been tested for chronic pain. This paper describes the study design and baseline characteristics of the enrolled sample for the Stepped Care to Optimize Pain care Effectiveness (SCOPE) study, a randomized clinical effectiveness trial conducted in five primary care clinics. SCOPE has enrolled 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity and randomized them to either the stepped care intervention or usual care control group. Using a telemedicine collaborative care approach, the intervention couples automated symptom monitoring with a telephone-based, nurse care manager/physician pain specialist team to treat pain. The goal is to optimize analgesic management using a stepped care approach to drug selection, symptom monitoring, dose adjustment, and switching or adding medications. All subjects undergo comprehensive outcome assessments at baseline, 1, 3, 6 and 12 months by interviewers blinded to treatment group. The primary outcome is pain severity/disability, and secondary outcomes include pain beliefs and behaviors, psychological functioning, health-related quality of life and treatment satisfaction. Innovations of SCOPE include optimized analgesic management (including a stepped care approach, opioid risk stratification, and criteria-based medication adjustment), automated monitoring, and centralized care management that can cover multiple primary care practices.
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The PHQ-9 and GAD-7 are among the best validated and most commonly used measures of depression and anxiety, respectively.
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From Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials (2016) · cites this paper as [25]
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Self-citation
- Authors
- Kroenke, K., Krebs, E., Wu, J., Bair, M. J., Damush, T., Chumbler, N., York, T., Weitlauf, S., McCalley, S., Evans, E., Barnd, J., & Yu, Z.
- Affiliations
- Regenstrief Institute (US)
- University of Minnesota (US)
- Indiana University School of Medicine (US)
- University of Georgia (US)
- Richard L. Roudebush VA Medical Center (US)
- Corresponding author
- Kroenke, Kurt
- Venue
- Contemporary Clinical Trials
- Publisher
- Elsevier BV
- Published
- 2013-03
- Volume
- 34
- Issue
- 2
- Pages
- 270-281
- ISSN
- 1551-7144 (ISSN-L)
- OpenAlex
- W2016267471
- Cited by
- 63
- References
- 73
- Citations by year
- 2026: 3 · 2025: 3 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 9 · 2015: 10 · 2014: 8 · 2013: 2
- FWCI
- 4.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Contemporary Clinical Trials (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- chronic musculoskeletal pain, stepped care, telemedicine, collaborative care, analgesic treatment, medication adjustment, veterans, primary care, nurse care managers, health-related quality of life
- MeSH terms
- Adult, Aged, Algorithms, Ambulatory Care Facilities, Analgesics, Female, Humans, Male, Middle Aged, Pain Measurement, Patient Care Team, Primary Health Care, Telephone, United States, United States Department of Veterans Affairs, Treatment Outcome, Telemedicine, Veterans Health, Chronic Pain, Pain Management
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