Carol G.T. Vance , Dana L. Dailey , Lynn Nakad , David A. Katz , Nicholas R. Butler , Stacey A. Appenheimer , Stephanie H. Gilbertson-White , Jennie Embree , Sandra E. Daack-Hirsch , Kathleen A. Sluka , Barbara A. Rakel
{"title":"在初级保健诊所实施两种非药物疼痛处方治疗肌肉骨骼疼痛。","authors":"Carol G.T. Vance , Dana L. Dailey , Lynn Nakad , David A. Katz , Nicholas R. Butler , Stacey A. Appenheimer , Stephanie H. Gilbertson-White , Jennie Embree , Sandra E. Daack-Hirsch , Kathleen A. Sluka , Barbara A. Rakel","doi":"10.1016/j.cct.2025.108047","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Chronic pain affects over 50 million Americans and is the main reason for primary care consultations. Clinical practice guidelines recommend use of non-drug therapies as first-line treatments. However, adoption and implementation of these guidelines are hindered by logistics. Exercise and transcutaneous electrical nerve stimulation (TENS) are effective non-drug strategies for managing chronic musculoskeletal pain, both of which have shown to reduce opioid usage. This study presents the results of implementing the Bundle for Exercises and TENS (BEsT) in primary care to facilitate prescription of non-drug therapy.</div></div><div><h3>Methods</h3><div>We developed an electronic bundle to facilitate prescription of TENS and exercise and trained providers to utilize the bundle. We identified providers who treated chronic pain from three primary care clinics to implement BEsT. Provider behaviors in prescribing TENS, exercise, opioids, non-opioid analgesics, and physical/occupational therapy (PT/OT) referrals were tracked. Surveys and focus groups captured provider perceptions of BEsT.</div></div><div><h3>Results</h3><div>After implementation of BesT, TENS prescription rates increased during training and were maintained in the 6–9 month follow up periods. Exercise prescriptions only increased during training. Across all clinics, opioid prescriptions decreased from 26 % to 14 %. Providers highlighted the auto-populate feature, patient education materials, and reduced opioid use as advantages of BEsT, but also noted increased time and staff burdens and workflow disruptions.</div></div><div><h3>Conclusions</h3><div>Providing decision making tools within provider workflow can increase use of non-drug therapy by primary care providers for chronic pain. However, prescriptions for non-drug therapies are hindered by increased the time and perceived burden to prescribe.</div></div>","PeriodicalId":10636,"journal":{"name":"Contemporary clinical trials","volume":"156 ","pages":"Article 108047"},"PeriodicalIF":1.9000,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Implementation of two non-drug pain prescriptions for musculoskeletal pain in primary care clinics\",\"authors\":\"Carol G.T. Vance , Dana L. Dailey , Lynn Nakad , David A. Katz , Nicholas R. Butler , Stacey A. Appenheimer , Stephanie H. Gilbertson-White , Jennie Embree , Sandra E. Daack-Hirsch , Kathleen A. Sluka , Barbara A. Rakel\",\"doi\":\"10.1016/j.cct.2025.108047\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Chronic pain affects over 50 million Americans and is the main reason for primary care consultations. Clinical practice guidelines recommend use of non-drug therapies as first-line treatments. However, adoption and implementation of these guidelines are hindered by logistics. Exercise and transcutaneous electrical nerve stimulation (TENS) are effective non-drug strategies for managing chronic musculoskeletal pain, both of which have shown to reduce opioid usage. This study presents the results of implementing the Bundle for Exercises and TENS (BEsT) in primary care to facilitate prescription of non-drug therapy.</div></div><div><h3>Methods</h3><div>We developed an electronic bundle to facilitate prescription of TENS and exercise and trained providers to utilize the bundle. We identified providers who treated chronic pain from three primary care clinics to implement BEsT. Provider behaviors in prescribing TENS, exercise, opioids, non-opioid analgesics, and physical/occupational therapy (PT/OT) referrals were tracked. Surveys and focus groups captured provider perceptions of BEsT.</div></div><div><h3>Results</h3><div>After implementation of BesT, TENS prescription rates increased during training and were maintained in the 6–9 month follow up periods. Exercise prescriptions only increased during training. Across all clinics, opioid prescriptions decreased from 26 % to 14 %. Providers highlighted the auto-populate feature, patient education materials, and reduced opioid use as advantages of BEsT, but also noted increased time and staff burdens and workflow disruptions.</div></div><div><h3>Conclusions</h3><div>Providing decision making tools within provider workflow can increase use of non-drug therapy by primary care providers for chronic pain. However, prescriptions for non-drug therapies are hindered by increased the time and perceived burden to prescribe.</div></div>\",\"PeriodicalId\":10636,\"journal\":{\"name\":\"Contemporary clinical trials\",\"volume\":\"156 \",\"pages\":\"Article 108047\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-08-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Contemporary clinical trials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1551714425002411\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Contemporary clinical trials","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1551714425002411","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
Implementation of two non-drug pain prescriptions for musculoskeletal pain in primary care clinics
Background
Chronic pain affects over 50 million Americans and is the main reason for primary care consultations. Clinical practice guidelines recommend use of non-drug therapies as first-line treatments. However, adoption and implementation of these guidelines are hindered by logistics. Exercise and transcutaneous electrical nerve stimulation (TENS) are effective non-drug strategies for managing chronic musculoskeletal pain, both of which have shown to reduce opioid usage. This study presents the results of implementing the Bundle for Exercises and TENS (BEsT) in primary care to facilitate prescription of non-drug therapy.
Methods
We developed an electronic bundle to facilitate prescription of TENS and exercise and trained providers to utilize the bundle. We identified providers who treated chronic pain from three primary care clinics to implement BEsT. Provider behaviors in prescribing TENS, exercise, opioids, non-opioid analgesics, and physical/occupational therapy (PT/OT) referrals were tracked. Surveys and focus groups captured provider perceptions of BEsT.
Results
After implementation of BesT, TENS prescription rates increased during training and were maintained in the 6–9 month follow up periods. Exercise prescriptions only increased during training. Across all clinics, opioid prescriptions decreased from 26 % to 14 %. Providers highlighted the auto-populate feature, patient education materials, and reduced opioid use as advantages of BEsT, but also noted increased time and staff burdens and workflow disruptions.
Conclusions
Providing decision making tools within provider workflow can increase use of non-drug therapy by primary care providers for chronic pain. However, prescriptions for non-drug therapies are hindered by increased the time and perceived burden to prescribe.
期刊介绍:
Contemporary Clinical Trials is an international peer reviewed journal that publishes manuscripts pertaining to all aspects of clinical trials, including, but not limited to, design, conduct, analysis, regulation and ethics. Manuscripts submitted should appeal to a readership drawn from disciplines including medicine, biostatistics, epidemiology, computer science, management science, behavioural science, pharmaceutical science, and bioethics. Full-length papers and short communications not exceeding 1,500 words, as well as systemic reviews of clinical trials and methodologies will be published. Perspectives/commentaries on current issues and the impact of clinical trials on the practice of medicine and health policy are also welcome.