Integrated Pain Team Programs Improve Outcomes for Chronic Pain and May Reduce Reliance on High-Risk Opioid Therapy
Biopsychosocial Integrated Pain Team (IPT) care models are being implemented in VA and other healthcare systems to address chronic pain and reduce risks related to long-term opioid therapy, with little evaluation of effectiveness to date. Expert recommendations suggest that integrated chronic pain care involve interdisciplinary, evidence-based multimodal treatment options, including cognitive behavioral therapy, exercise therapy, and non-opioid medications. As a national integrated healthcare system with interdisciplinary clinical models embedding behavioral health and specialty care within general medical settings, VA is ideally suited to advance IPT clinical models. This study examined changes in self-reported chronic pain-, opioid-, and treatment-related outcomes among Veterans with chronic pain following the implementation of a primary care-based IPT model within the San Francisco VA Health Care System. Enrollment in the study was open to all patients who began IPT care between November 2015 and February 2018. The primary outcomes for the 99 Veterans in this study cohort included pre- and post- comparisons of pain experience and opioid misuse.
- Veterans with chronic pain who engaged in a primary care-based IPT program reported improvement in several outcomes related to pain-related distress and disability, and opioid misuse.
- While patients did not report a significant change in pain severity from baseline to follow-up, they did report significantly reduced pain interference in daily functioning. Pain catastrophizing also showed significant reduction, driven by decreases in pain-related magnification and helplessness.
- Regarding the 71 patients prescribed opioids at both baseline and follow-up, opioid misuse decreased significantly. For example, there was a significant reduction in the frequency of opioid misuse behaviors, including getting into arguments or making emergency phone calls.
- At follow-up versus baseline, patients reported increased use of integrative (i.e., acupuncture 26% vs 11%) and active pain management strategies (i.e., exercise, 16% vs 8%), and were less likely to use only pharmacological pain management strategies (5% vs 19%).
- Findings suggest that primary care-based IPT programs may improve patient-centered outcomes for individuals with chronic pain and reduce reliance on potentially high-risk opioid therapy.
- This was a single-group quality improvement study using a convenience sample, thus, pre- and post- comparisons of outcomes can suggest, but not demonstrate causality of engagement in IPT.
- Measures of pain experience and opioid misuse were self-reported using validated measures, and responses may be influenced by unmeasured factors.
This study was partly funded through HSR&D’s Quality Enhancement Research Initiative (QUERI), and an HSR&D Career Development Award to Dr. Gibson, who is part of the San Francisco VA Medical Center
Gibson C, Grasso J, Li Y, et al. An Integrated Pain Team Model: Impact on Pain-Related Outcomes and Opioid Misuse in Patients with Chronic Pain. Pain Medicine. February 25, 2020; Epub ahead of print.