Teaming in Interdisciplinary Chronic Pain Management Interventions in Primary Care: a Systematic Review of Randomized Controlled Trials

Natalie B. Connell, Pallavi Prathivadi, Karl A. Lorenz, Sophia N. Zupanc, Sara J. Singer, Erin E. Krebs, Elizabeth M. Yano, Hong nei Wong, Karleen F. Giannitrapani

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

Background: Current pain management recommendations emphasize leveraging interdisciplinary teams. We aimed to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings. Methods: We searched PubMed, EMBASE, and CINAHL for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (e.g., BPI total pain, GCPS pain intensity, RMDQ pain-related disability), include primary care as an intervention setting, and demonstrate some evidence of teamwork or teaming; specifically, they needed to involve at least two clinicians interacting with each other and with patients in an ongoing process over at least two timepoints. We assessed study quality with the Cochrane Risk of Bias tool. We narratively synthesized intervention team structures and processes, comparing among interventions that reported a clinically meaningful improvement in patient-reported pain outcomes defined by the minimal clinically important difference (MCID). Results: We included 13 total interventions in our review, of which eight reported a clinically meaningful improvement in at least one patient-reported pain outcome. No included studies had an overall high risk of bias. We identified the role of a care manager as a common structural feature of the interventions with some clinical effect on patient-reported pain. The team processes involving clinicians varied across interventions reporting clinically improved pain outcomes. However, when analyzing team processes involving patients, six of the interventions with some clinical effect on pain relied on pre-scheduled phone calls for continuous patient follow-up. Discussion: Our review suggests that interdisciplinary interventions incorporating teamwork and teaming can improve patient-reported pain outcomes in comparison to usual care. Given the current evidence, future interventions might prioritize care managers and mechanisms for patient follow-up to help bridge the gap between clinical guidelines and the implementation of interdisciplinary, team-based chronic pain care.

Original languageEnglish (US)
Pages (from-to)1501-1512
Number of pages12
JournalJournal of general internal medicine
Volume37
Issue number6
DOIs
StatePublished - May 2022

Bibliographical note

Funding Information:
1. Contributors: We would like to thank Dr. Lisa Rubenstein for her thoughtful comments to help improve this manuscript. 2. Funders: This project is a component of Dr. Karleen Giannitrapani’s VA HSR&D CDA (#19-075). Dr. Yano’s effort was funded by a VA HSR&D Senior Research Career Scientist Award (Project #RCS 05-195).

Funding Information:
2. Funders: This project is a component of Dr. Karleen Giannitrapani’s VA HSR&D CDA (#19-075). Dr. Yano’s effort was funded by a VA HSR&D Senior Research Career Scientist Award (Project #RCS 05-195).

Publisher Copyright:
© 2022, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

Keywords

  • Chronic pain
  • Interdisciplinary team
  • Primary care
  • Systematic review
  • Chronic Pain/therapy
  • Bias
  • Humans
  • Pain Management
  • Primary Health Care
  • Randomized Controlled Trials as Topic

PubMed: MeSH publication types

  • Systematic Review
  • Research Support, U.S. Gov't, Non-P.H.S.

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