After integrative care for pain at the anthroposophical hospital Vidarkliniken in Sweden, prescriptions for pain medications could be halved. Patients in conventional care however, purchased twice as many analgesics as before treatment. These are some results of a unique comparative study published in the high impact journal PLOS One. Physician Hans Johansson, Södertälje Hospital (not involved with the study), says that it is interesting and important.
The international study was conducted by researchers affiliated with IC – The Integrative Care Science Center, Karolinska Institutet, Göteborg University, Samueli Institute in the USA and universities in Coburg and Bad Tölz, Germany. It is published in PLOS One, one of the world´s leading scientific journals.
High Price of Pain
In varying degrees, pain affects over half a million people in Sweden with a high price in human suffering and several tens of billion SEK (Swedish kronor) in estimated total costs for society.
For the first time, researchers have compared trends in drug prescribing and costs over time for patients in conventional and integrative care. In this case, the integrative care given at the anthroposophical hospital Vidarkliniken, Järna, some 50 kilometers south of Stockholm, the Swedish capital.
All the patients suffered from pain. The so called registry study was based on data from the Stockholm County Council and the Swedish national drug registry maintained by the National Board of Health and Welfare. The study was co-funded by non-profit foundations in the four countries. Neither the backers nor the hospital Vidarkliniken has had any influence on the study.
Repeated Measurements
The study included 213 women at Vidarkliniken and 1050 matched control patients in conventional care in Stockholm County Council, a total of 1263 patients.
The patients’ intake of analgesic (pain) prescription drugs were measured at 90 days and 180 days before and after starting treatment. At 90 days, those receiving integrative anthroposophical treatment had halved their need for drugs (as measured by those prescribed and sold), while patients receiving conventional care were prescribed and sold almost twice as much pain medication after 90 days. At 180 days, the differences between the groups was even greater.
Significant Differences
Associate Professor Torkel Falkenberg, one of the researchers, and the Head of I C says:
– We are dealing with significant differences between the groups, which also increased over time, as the graphs show. Before the health care interventions, the patient groups, however, showed no significant differences in prescribing. In addition, it seems that the number of return visits for in-patient care was lower for pain patients receiving integrative care at Vidarkliniken. In previous studies, we have shown that quality of life and pain improved in pain patients receiving integrative care. This suggests that these patients reduced their need both for pain medications and for certain types of medical care.
Consistent with Policy
The study results are in line with the policy in Stockholm County Council. On the evidence-based decision support website Viss.nu (in Swedish), run by the council, an expert document on chronic, non-malignant pain states that: ” It should be emphasized that in most cases, pharmacotherapy has a limited role to play in chronic pain. ”
The measured differences in prescribing suggest that there is money to be saved in terms of care of pain patients (in addition to the alleviation of human suffering). This applies to drugs but might also include costs for health care, sick leave and production losses. Questions which need to be addressed in future studies.
” We Have a Lot to Learn ”
The physician Hans Johansson, a specialist in geriatrics and pain management with in-depth knowledge in palliative medicine at Södertälje Hospital was not involved in the study. He says the retrospective study is interesting and important because drug therapy has a limited place in the treatment of chronic pain.
– Other treatment strategies and therapies are necessary and must be developed to alleviate the undue amount of pain suffered by too many people, and we have a lot to learn from integrative care.
Prospective Studies Needed
We also need additional prospective clinical trials, Hans Johansson says. Such studies will make it possible to match the groups to be compared even better.
For example, treatment groups can be matched better with regards to the patient’s preferences, the extent to which patients receive inpatient or outpatient care, and which elements of care are provided. Hans Johansson also looks forward to seeing more research that highlights the possible mechanisms behind the results.
David Finer
Reference
Sundberg T, Petzold M , Kohls N , Falkenberg T. Opposite Drug Prescription and Cost Trajectories Following Integrative and Conventional Care for Pain – A Case -Control Study. PLOS One. Published : May 14, 2014. DOI: 10.1371/journal.pone.0096717. PDF.
Tags: anthroposophical integrative care, BMC Complementary and Alternative Medicine, CAM, case-control study, complementary and alternative medicine, David Finer, drug utilization, evidence, health, health care, health care cost, health economics, I C, integrative care, Integrative Care Science Center, integrative medicine, Karolinska Institutet, National Board of Health and Welfare, pain, prescribing, prospective, research, retrospective, Tobias Sundberg, Torkel Falkenberg, Vidarkliniken
