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

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Abstract

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.

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Funding

This research was supported by the VA Center for Integrated Healthcare.

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Authors and Affiliations

  1. Department of Community Health & Health Behavior, School of Public Health & Health Professions, State University of New York at Buffalo, Buffalo, NY, 14214, USA

    Sarah Cercone Heavey PhD, MPH, Jacob Bleasdale PhD, MS & Gregory P. Beehler PhD, MA

  2. VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY, USA

    Sarah Cercone Heavey PhD, MPH & Gregory P. Beehler PhD, MA

  3. National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, CA, USA

    Eve A. Rosenfeld PhD

  4. Deparment of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA

    Eve A. Rosenfeld PhD

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  1. Sarah Cercone Heavey PhD, MPH
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  4. Gregory P. Beehler PhD, MA
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Correspondence to Sarah Cercone Heavey PhD, MPH.

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Heavey, S.C., Bleasdale, J., Rosenfeld, E.A. et al. Collaborative Care Models to Improve Pain and Reduce Opioid Use in Primary Care: a Systematic Review. J GEN INTERN MED 38, 3021–3040 (2023). https://doi.org/10.1007/s11606-023-08343-9

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