Computerized decision-support systems for chronic pain management in primary care

Objective. Computerized decision-support systems (CDSSs) can offer clinical guidance, as well as promote doctor-patient collaboration and patient self-care. As such, they have great potential for improving chronic pain management, particularly in the primary care setting, where physicians often lack sufficient pain-specific clinical expertise and communication skills. The objective of this study was to examine the use of CDSSs in chronic pain management, and to review the evidence for their feasibility and effectiveness. Design. A review of the available literature using search terms associated with computerized decision-support and chronic pain management. Major databases searched included: MEDLINE, CINAHL, PsychINFO, HealthSTAR, EMBASE, Cochrane Library, Computer and Information Systems Abstracts, and Electronics and Communications Abstracts. Descriptive and evaluative studies were included. Results. Nine studies describing eight CDSSs met study inclusion criteria. With but two exceptions, CDSSs were specific to a pain-related condition(s). All were designed to assist clinicians to manage pain medically. Aside from pain status, input specifications differed markedly. Evaluative studies were exclusively feasibility studies and varied widely in design and level of description. All were nonexperimental; most were methodologically weak. Two primary care studies were reported. Patient and clinician acceptability ratings of CDSSs ranged from moderate to high. Due to insufficient data, definitive conclusions concerning the impact of CDSSs on provider performance and patient outcomes were not possible. Conclusion. Research on CDSSs in chronic pain management is limited. The effects of CDSSs on provider and patient outcomes remain understudied, and their potential to improve doctor-patient collaboration and self-care largely untested.