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2019 HSR&D/QUERI National Conference Abstract

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1153 — Change in pain-related outcomes and opioid misuse among chronic pain patients enrolled in an Integrated Pain Team Clinic

Lead/Presenter: Carolyn Gibson,  San Francisco VA Health Care System
All Authors: Gibson CJ (San Francisco VA Health Care System; University of California, San Francisco), Li Y (San Francisco VA Health Care System), Grasso, J (San Francisco VA Health Care System) Purcell, N (San Francisco VA Health Care System; University of California, San Francisco) Tighe, J (San Francisco VA Health Care System) Zamora, K (San Francisco VA Health Care System) Nicosia, F (San Francisco VA Health Care System; University of California, San Francisco) Seal, KH (San Francisco VA Health Care System; University of California, San Francisco)

Objectives:
Biopsychosocial, integrated pain care models are increasingly implemented in the VA to better address chronic pain care and risks related to opioid therapy, but little evaluation of their effectiveness has been completed to date. In this study, we examined whether the Integrated Pain Team (IPT) model improves self-reported chronic pain-related outcomes and opioid misuse.

Methods:
Using paired t-tests and Wilcoxon matched-pairs signed-ranks tests, we examined change in self-reported pain experience (Brief Pain Inventory, Pain Catastrophizing Scale), opioid misuse (Current Opioid Misuse Measure), treatment satisfaction (Pain Treatment Satisfaction Scale), and pain management strategies among chronic pain patients before and after completion of > = 3 IPT clinical encounters.

Results:
In this sample of Veterans with chronic pain (n = 99; mean age 60 years, SD 13; 84% male) engaged in IPT over an average of 14.3 (SD 9) weeks, most patients reported improvement in pain- and opioid-related outcomes, though not pain severity. Patients noted significant improvement in pain interference (baseline mean 46.0, SD 15.9 vs follow-up mean 40.5, SD 16.2, p < .001; Cohen's d .37), pain catastrophizing (baseline mean 22.9, SD 13.0 vs follow-up mean 19.3, SD 14.1, p = .01; Cohen's d .30), and satisfaction with information received about pain/pain treatment (i.e., 13.1% "very satisfied" at baseline vs. 25.3% at follow-up, p = .01). Self-reported opioid misuse also declined among the 71 patients who were prescribed opioids at both timepoints (baseline COMM mean 11.0, SD 7.5 vs mean 8.2, SD 6.1, p = .01; Cohen's d .40). Patients broadly reported increased use of integrative (i.e., acupuncture, 11% at baseline vs 26% at follow-up, p < .01) and active (i.e., exercise, 8% at baseline vs.16% at follow-up, p < .01) pain management strategies over the observed period, and were less likely to report use of no non-pharmacological pain management strategies after engagement in IPT (19% at baseline vs. 5% at follow-up, p < .01).

Implications:
Chronic pain patients in IPT generally reported improvement in a variety of key outcomes related to distress and disability, despite pain severity remaining unchanged on average.

Impacts:
Integrated pain care models are promising in improving quality of life and reducing reliance on potentially high-risk opioid therapy for individuals living with chronic pain.