» Back to list of all Management eBriefs
|Issue 125||April 2017|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Pain
Chronic musculoskeletal pain is a growing burden on today's Veteran population. Studies of Veterans who served in Iraq and Afghanistan show that musculoskeletal system diseases are the most frequent diagnoses in inpatient and outpatient encounters, even surpassing mental health conditions. Pain is a complex condition involving dynamic interactions between biological, psychological, and social factors unique to each individual. For this reason, pain care needs to be individually tailored, involving multiple care approaches and collaboration between primary and specialty care clinicians. Pain management guidelines, including those for the VA, advocate for multimodal pain care. However, primary care providers (PCPs), who are responsible for the majority of pain management, face many system- and patient-level challenges in providing the recommended multimodal interventions. Therefore, this Evidence Brief sought to:
Investigators with VA's Evidence-based Synthesis Program Center located in Portland, OR searched multiple data sources (i.e., MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, etc.) for relevant articles through October 2016. After reviewing 901 records identified through this search and via reference lists and hand-searching, they identified 12 articles, including 1 secondary study, that were relevant to their analysis. Overall, most studies referenced in these articles were fair to good quality, with three rated as poor.
Summary of Findings
Findings from ESCAPE, SEACAP, SCAMP, and SCOPE have the highest applicability to Veterans because they were studied in VA settings. However, as each of the top five models is only supported by a single study with imprecise findings, current evidence leaves sufficient doubt about their findings to recommend further research.
Compared to VA-based models, in the remaining models conducted in other non-VA settings, decision support components were less common, and case management teams were more diverse, representing: occupational therapy, social work, physical therapy, physiatry, pharmacy, physiotherapy, kinesiology, and dietary needs. Mental health treatment was more often a required component, and patient self-management support was more often passive in nature.
For additional related evidence review work, an updated review of the state-of-the-science of chronic pain outcome assessment could be useful in informing the direction of future research. Also, as this is anticipated to continue to be an important clinical area in the future, with rapid evidence development expected, investigators suggest conducting an updated evidence review in a few years. For example, several additional multimodal chronic pain care models have already shown promise for improving patient outcomes in single-arm studies, and they also identified several ongoing studies which may fill gaps in existing research or provide further support for various models of pain care.
Please feel free to forward this information to others!
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
See all reports online.