Care Models to Improve Pain and Reduce Opioids Among Patients Prescribed Long-Term Opioid Therapy
Creators: name: Herbst, Ellen
name: Kerns, Robert D.
name: Librodo, Sara
name: Naylor, Jennifer C.
name: Becker, William C.
name: Marraffa, Rebecca A.
name: Jensen, Agnes C.
name: Seal, Karen H.
name: Kats, Allyson M.
name: Frank, Joseph W.
name: Lagisetty, Pooja
name: Barbosa, Monica R.
name: Purcell, Natalie
name: Williams, Beth E.
name: Bohnert, Amy
name: Borsari, Brian
name: Mapara, Payal S.
name: Garvey, Caitlin
name: Krebs, Erin E.
name: Allen, Kelli D.
name: Hudson, Teresa J.
name: Hagedorn, Hildi J.
name: Okere, Jennifer B.
name: Hammett, Patrick
name: DeRonne, Beth M.
name: Morasco, Benjamin J.
name: Son, Elizabeth
name: Jones, Elzie J.
name: Amundson, Erin C.
name: Baxley, Catherine
name: Noh, Maureen Y.
name: Manuel, Jennifer K.
name: Bhushan, Sujata
name: Pinsonnault, John
name: Mixon, Amanda S.
name: Reznik, Thomas E.
name: Seys, Randy L.
name: Makris, Una E.
name: Painter, Jacob T.
name: Nelson, David B.
name: Tat, Christina
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2025

description: <p>Patients prescribed long-term opioid therapy for chronic pain often experience unrelieved pain, poor quality of life, and serious adverse events. To compare the effects of integrated pain team (IPT) vs pharmacist collaborative management (PCM) on pain and opioid dosage. This study was a pragmatic multisite 12-month randomized comparative effectiveness trial with masked outcome assessment. Patients were recruited from October 2017 to March 2021; follow-up was completed June 2022. The study sites were Veterans Affairs primary care clinics. Eligible patients had moderate to severe chronic pain despite long-term opioid therapy (&ge;20 mg/d for at least 3 months). IPT involved interdisciplinary pain care planning, visits throughout 12 months with medical and mental health clinicians, and emphasis on nondrug therapies and motivational interviewing. PCM was a collaborative care intervention involving visits throughout 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. The primary outcome was pain response (&ge;30% decrease in Brief Pain Inventory total score) at 12 months. The main secondary outcome was 50% or greater reduction in opioid daily dosage at 12 months. A total of 820 patients were randomized to IPT (n = 411) or PCM (n = 409). Participants&rsquo; mean (SD) age was 62.2 (10.6) years, and 709 (86.5%) were male. A pain response was achieved in 58/350 patients in the IPT group (16.4%) vs 54/362 patients in the PCM group (14.9%) (odds ratio, 1.11 [95% CI, 0.74-1.67]; P = .61). A 50% opioid dose reduction was achieved in 102/403 patients in the IPT group (25.3%) vs 98/399 patients in the PCM group (24.6%) (odds ratio, 1.03 [95% CI, 0.75-1.42]; P = .85). Over 12 months, the mean (SD) Brief Pain Inventory total score improved from 6.7 (1.5) points to 6.1 (1.8) points (P &lt; .001) in IPT and from 6.6 (1.6) points to 6.0 (1.9) points (P &lt; .001) in PCM (between-group P = .82). Over 12 months, mean (SD) opioid daily dosage decreased from 80.8 (74.2) mg/d to 54.2 (65.0) mg/d in IPT (P &lt; .001) and from 74.5 (56.9) mg/d to 52.8 (51.9) mg/d (P &lt; .001) in PCM (between-group P = .22). Outcomes in this randomized clinical trial did not differ between groups; both had small improvements in pain and substantial reductions in opioid dosage. ClinicalTrials.gov Identifier: NCT03026790</p>