Pain is generally undertreated in the United States, owing to a number of barriers including geographic distance from specialty treatment providers; functional disability that limits mobility; treatment-related stigma; economic limitations; and educational barriers. Pain undertreatment exacerbates pain chronicity and emotional disruption that can significantly erode a pain patient’s quality of life, and there is widespread agreement that pain care must evolve to address this significant problem. The growing field of telehealth (defined for the purposes of this paper as technology that allows for distance interaction between providers and/or patients) offers a novel opportunity to expand pain assessment, consultation, and treatment services beyond the walls of the specialty pain clinic, but there is limited availability of resources describing how to best use this technology to improve access to care.

Some estimate that chronic pain affects over 35% of the U.S. population, resulting in over 100 million patients requiring specialty treatment. Unfortunately, it is likely that pain is generally undertreated, and there are a number of barriers that contribute to the undertreatment for pain including geographic distance from specialty treatment providers; functional disability that limits mobility; treatment-related stigma; economic limitations; and educational barriers. Pain undertreatment exacerbates pain chronicity and emotional disruption that can significantly erode a pain patient’s quality of life, and there is widespread agreement that pain care must evolve to address this significant problem. The growing field of telehealth (defined for the purposes of this paper as technology that allows for distance interaction between providers and/ or patients) offers a novel opportunity to expand pain assessment, consultation, and treatment services beyond the walls of the specialty pain clinic, but there is limited availability of resources describing how to best use this technology to improve access to care.

A recent literature review (September 2011) using MeSH search criteria outlined by Hersh et al.6 revealed only 32 MEDLINE references focusing on telehealth for pain. This is surprising in light of the very large number of references covering telehealth and pain, respectively. Of the studies available, there are very few randomized trials of telehealth pain care and only one general overview of e-health and chronic pain, which dedicates just a few paragraphs to telehealth. This manuscript represents one of the first comprehensive reviews of the current state of telehealth and pain management research and practice. The goals are to provide a rationale for the potential benefit of telehealth-based pain management services; describe the various applications of telehealth technology for pain management; orient the reader to cost models for telehealth; present examples of services in place; and offer recommendations for future research based on the current state of knowledge.

Undertreatment for pain is a well-documented problem with numerous contributing factors including age, economics, infirmity, geography, lack of knowledge about specialty care, and stigma of pain treatment.3,7 Timely access to pain specialty care is a major contributor to suffering, increased healthcare utilization, and chronic pain development,8 and specialty providers are often a ‘‘last stop’’ in pain referral pathways, with some pain sufferers waiting over 3 years before pain symptoms

are fully addressed. The International Association for the Study of Pain has recommended a wait of no longer than 8 weeks to address uncomplicated pain, and they encourage more effective pain care through ‘‘building the capacity (of medical care systems) to provide timely and appropriate treatment for the management of pain’’. The Canadian Pain Society Wait Times Task Force examined over 3,000 studies of access to pain treatment and found that wait times for pain specialty care services often exceed 6 months, even when the services were geographically available. This finding is quite disconcerting in light of evidence showing that wait times of 6 months or more contribute to decrements in mood and disability that adversely affect quality of life. One possible option to improve pain care is to increase the role of general practitioners in pain management services.

Evidence has shown, however, that non-specialty providers (eg, primary care) may not adequately utilize the best available pain management techniques, so patients should be referred for specialty treatment rather than receive pain services in non-specialty venues.11 Timely specialty referrals, however, are infrequent. Coulter and colleaguesexamined general practitioner (GP) referrals to outpatient pain specialty services and found that <25% of GPs referred a back pain patient for specialty care within 6 months of pain onset, and almost 60% of patients were treated by a GP before a specialty referral was considered. General practitioners want their patients to receive the care they need, and some studies show that GPs would prefer referring to specialty care to managing pain themselves. On the basis of this evidence, it can be assumed that low rates of specialty referrals are most likely attributable to systemic barriers like a lack of specialty care access in the area, prohibitive costs of specialty pain care, and providers’ lack of awareness regarding referral options.

There are multiple ways to organize telehealth networks, but the most predominant models involve ‘‘store-and-forward’’ mechanisms and technologies that facilitate direct contact with specialty consultants or patients. Each model offers a unique set of benefits and limitations, so the providers should carefully consider their treatment needs and personal preferences before committing to any single telehealth structure. Telehealth formats are described briefly below, and examples have been provided (when available) to orient the reader to exemplary programs.

Source: PubMed