Collaborative Care Models to Improve Pain and Reduce Opioid Use in Primary Care: a Systematic Review

• Published in: Journal of general internal medicine : JGIM Vol. 38; no. 13; pp. 3021 - 3040
• Main Authors: Heavey, Sarah Cercone, Bleasdale, Jacob, Rosenfeld, Eve A., Beehler, Gregory P.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-10-2023; Springer Nature B.V
• Subjects: Analgesics, Opioid - therapeutic use; Buprenorphine; Buprenorphine - therapeutic use; Chronic pain; Chronic Pain - drug therapy; Clinical trials; Collaboration; Drug abuse; Drug addiction; Fractures; Health services; Humans; Internal Medicine; Literature reviews; Medicine; Medicine & Public Health; Narcotics; Opioid-Related Disorders - drug therapy; Opioids; Pain; Primary care; Primary Health Care; Statistical analysis; Substance use disorder; Systematic Review; pain; collaborative care model; systematic review; opioids
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-023-08343-9

Background
Collaborative care management (CCM) is an empirically driven model to overcome fractured medical care and improve health outcomes. While CCM has been applied across numerous conditions, it remains underused for chronic pain and opioid use. Our objective was to establish the state of the science for CCM approaches to addressing pain-related outcomes and opioid-related behaviors through a systematic review.
Methods
We identified peer-reviewed articles from Cochrane, Embase, PsycINFO, and PubMed databases from January 1, 1995, to October 31, 2022. Abstracts and full-text articles were screened for study inclusion, resulting in 18 studies for the final review. In addition, authors used the Patient-Centered Integrated Behavioral Health Care Principles and Tasks Checklist as a tool for assessing the reported CCM components within and across studies. We conducted this systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.
Results
Several CCM trials evidenced statistically significant improvements in pain-related outcomes (
n
 = 11), such as pain severity and pain-related activity interference. However, effect sizes varied considerably across studies and some effects were not clinically meaningful. CCM had some success in targeting opioid-related behaviors (
n
 = 4), including reduction in opioid prescription dose. Other opioid-related work focused on CCM to facilitate buprenorphine treatment for opioid use disorder (
n
 = 2), including improved odds of receiving treatment and greater prevalence of abstinence from opioids and alcohol. Uniquely, several interventions used CCM to target mental health as a way to address pain (
n
 = 10). Generally, there was moderate alignment with the CCM model.
Conclusions
CCM shows promise for improving pain-related outcomes, as well as facilitating buprenorphine for opioid use disorder. More robust research is needed to determine which aspects of CCM best support improved outcomes and how to maximize the effectiveness of such interventions.