Smith MY et al. 2007 "Computerized decision-support systems for chronic pain management in primary care."

Smith MY, Depue JD, Rini C. Computerized decision-support systems for chronic pain management in primary care. Pain Med 2007;8:S155-S166.
"Objective: Computerized decision-support systems (CDSSs) can offer clinical guidance, as well as promote doctor-patient collaboration and patient self-care. As such, they can 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 non-experimental; 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 largely understudied, and their potential to improve doctor-patient collaboration and self-care largely untested."
To examine the use of computerized decision support systems (CDSSs) "in chronic pain management, and to review the evidence for their feasibility and effectiveness."
Type Clinic
Primary care and specialty care
not applicable
Type of Health IT
Decision support system
Type of Health IT Functions
Functions were varied across eight discrete systems but included the following: assistance in diagnosing and/or managing chronic pain; health care provider education; a query system in which the providers could ask the system for explanations, therapeutic rationale, and therapy guidelines; and interactive patient education tools.
Workflow-Related Findings
"Poor usability and practitioner nonacceptance of computer recommendations can serve as significant barriers to system adoption in routine clinical practice."
Pilot test "[r]esults consistently showed high acceptability of ... two CDSSs [by patients] and 100% completion rates in terms of data input [by patients]. The average amount of time required ranged from a high of 38 minutes to a low of 14 minutes."
In two studies, "physicians found the system to be moderately easy to use and of some clinical worth."
Results regarding the effect of two CDSSs on patient-physician communication were contradictory. "Of the 41 outpatients who used [one CDSS], approximately 68% states that it had not affected their pain-related communication. Some, however, felt that they talked more precisely and explicitly about their pain as a result of using it.... In contrast, 86% of users of [another CDSS] cited it as beneficial for patient-doctor pain-related communication and that it 'freed them to describe their pain'".
Study Design
Systematic literature review
Study Participants
The authors conducted an English-language search of the following databases: MEDLINE (1966 - April 2006), CINAHL (1982 - April 2006), PsychINFO (1967 - April 2006), HealthSTAR (1981 - April 2006), EMBASE, Cochrane Library, Computer and Information Systems Abstracts, Proust Digital Dissertations, Computer Retrieval of Information on Scientific Projects (CRISP), LISA, ERIC, Computer and Information Systems Abstracts, and Dissertation Abstracts. Primary search terms included the following: "computer generated decision support systems and expert systems." To be eligible for inclusion in the final set, studies had to describe "the development and/or application of a CDSS, or expert system in the context of chronic pain management." Nine relevant studies were found, describing eight distinct decision support systems.