Results Summary

What was the research about?

Chronic pain is pain that lasts for months or years. Medicines called opioids can treat chronic pain. But people who use opioids for a long time are at risk for health problems like addiction, overdose, and injuries.

In this study, the research team compared two types of chronic pain care for veterans in reducing pain and daily dose of opioids:

  • Integrated pain team, or IPT. In this group, veterans received care from a team that included a doctor, a mental health therapist, and a rehabilitation therapist or pharmacist. They had at least three visits with the doctor. They also had eight phone calls with the mental health therapist. The calls focused on providing support and resources to help veterans follow their pain care plan.
  • Telecare collaborative management, or TCM. In this group, veterans received care led by a pharmacist. They had at least six visits with the pharmacist, who monitored symptoms and adjusted pain medicines.

For veterans receiving high-dose opioids, the research team also compared offering versus not offering the option to switch to buprenorphine, a medicine that can treat pain or opioid use disorder.

What were the results?

After one year, veterans who received the two types of care didn’t differ in overall pain or daily dose of opioids. Veterans receiving IPT or TCM had:

  • Less pain overall
  • Lower daily doses of opioids

The two types of care didn’t differ in how much these outcomes improved.

For veterans receiving high-dose opioids, those who were or were not offered buprenorphine didn’t differ in overall pain or daily dose of opioids.

Who was in the study?

The study included 820 veterans with chronic pain who were prescribed daily opioids for at least three months. Of these veterans, 74 percent were White, 16 percent were Black, 5 percent were Hispanic, 5 percent were more than one race or ethnicity, and 3 percent were another ethnicity. The average age was 62, and 86 percent were men. All received care at one of 10 Veterans Affairs, or VA, clinics. After one year, 712 veterans completed the study.

What did the research team do?

The research team assigned veterans by chance to receive IPT or TCM. They also assigned veterans on high-dose opioids to be offered or not offered the option to switch to buprenorphine.

At the start of the study and every three months for a year, veterans completed surveys about their pain. The research team looked at pharmacy records for the daily dose of opioids.

Veterans, doctors, and VA health system leaders helped throughout the study.

What were the limits of the study?

Most patients in the study were men, and all received care at VA hospitals. Results may differ for patients of other backgrounds or for those receiving care at other types of hospitals.

Future research could look at ways to reduce pain and opioid doses in non-VA populations.

How can people use the results?

Other VA clinics could use these results when considering ways to treat veterans with chronic pain.

PCORI identified unsafe opioid prescribing as an important research topic. Patients, clinicians, and others wanted to learn: How can primary care providers work with patients with noncancer pain to plan safe treatment and provide adequate pain management? To help answer this question, PCORI launched an initiative in 2016 on Strategies to Prevent Unsafe Opioid Prescribing in Primary Care among Patients with Acute or Chronic Noncancer Pain. The initiative funded this research project and others.

Final Research Report

This project's final research report is expected to be available by October 2024.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers lauded the researchers for addressing the PCORI methodology standards well but noted that the interventions studied meet criteria for complex health interventions. The reviewers asked the researchers to address those methodology standards as well. The researchers agreed that their study involved complex health interventions but explained that since those methodology standards had not been available when the study started, they were not able to address each part of the standards fully. However, they did add text to the report providing more information about the goals of the interventions and intervention components in order to address these standards at least partially.
  • The reviewers noted that the researchers reported 15 study-related hospitalizations and asked for more information about these hospitalizations and how they were related to the study. The researchers explained that they considered hospitalizations to be potentially study-related if the hospitalization was for chronic pain or opioid use in patients who were being managed by study clinicians.
  • The reviewers asked the researchers to consider whether their change in the cutoff eligibility for moderate-dose opioid therapy might have biased study results. The researchers stated that they did not consider the change in dose eligibility criteria and thresholds likely to bias the study results because their data indicated no differences in intervention effects related to the new enrollment categories.

Conflict of Interest Disclosures

Project Information

Erin Krebs, MD, MPH
University of Minnesota Twin Cities
$12,147,779
Comparative Effectiveness of Patient-Centered Strategies to Improve Pain Management and Opioid Safety for Veterans

Key Dates

July 2016
November 2023
2016
2023

Study Registration Information

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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: March 14, 2024