Care models reduce opioid dosage in patients with chronic pain
Care from an integrated pain team and pharmacist collaborative management each yielded similar small improvements in pain and substantial reductions in opioid dosage among U.S. veterans taking long-term opioids for chronic pain, a study found.
Primary care-based interventions can achieve a safe reduction of opioids among patients receiving long-term opioid therapy, a study found.
To compare the effects of care from an integrated pain team versus pharmacist collaborative management on pain and opioid dosage, researchers conducted a pragmatic 12-month randomized comparative effectiveness trial at 10 Veterans Affairs primary care clinics. Patients were recruited from October 2017 to March 2021 and were followed until June 2022.
Eligible patients had moderate to severe chronic pain despite long-term opioid therapy (≥20 mg/d for ≥3 months). The primary outcome was defined as pain response (≥30% decrease in Brief Pain Inventory total score) at 12 months, and the main secondary outcome was defined as a reduction in opioid daily dosage of 50% or greater at 12 months.
The integrated pain team provided interdisciplinary pain care planning, visits over 12 months with medical and mental health clinicians, and emphasis on nondrug therapies and motivational interviewing. Pharmacist collaborative management was a collaborative care intervention involving visits over 12 months with a clinical pharmacist care manager who conducted structured monitoring and medication optimization. Both interventions provided individualized pain care and opioid tapering recommendations to patients. Results of the study were published Dec. 9 by JAMA Internal Medicine.
A total of 820 patients were randomized to the integrated pain team (n=411) or pharmacist collaborative management (n=409), and 721 completed the 12-month study. Outcomes did not differ between groups, each of which had small improvements in pain and substantial reductions in opioid dosage. Overall, 58 of 350 patients in the integrated pain team group (16.4%) and 54 of 362 patients in the pharmacist collaborative management group (14.9%) achieved a pain response (odds ratio, 1.11 [95% CI, 0.74 to 1.67]; P=0.61), and102 of 403 patients (25.3%) and 98 of 399 patients (24.6%), respectively, achieved a 50% reduction in opioid dose (odds ratio, 1.03 [95% CI, 0.75 to 1.42]; P=0.85).
The researchers noted that the study was affected by the COVID-19 pandemic and that follow-up of patient-reported outcomes was incomplete, among other limitations. “Outcomes in this randomized comparative effectiveness trial did not differ between [integrated pain team] and [pharmacist collaborative management] groups. Both had small improvements in pain and substantial reductions in opioid dosage,” they wrote. “These results support the implementation of primary care-based collaborative care interventions to improve pain and opioid management among patients prescribed [long-term opioid therapy] for chronic pain,” the authors wrote.