Integrated and Comprehensive Pain Management Programs: Effectiveness and Harms

In this systematic review, the Agency for Healthcare Research and Quality (AHRQ) evaluated the effectiveness and harms of integrated (based in and integrated with primary care) and comprehensive (referral-based and separate from primary care) pain management programs, particularly in the Medicare population. Researchers found that:

• Integrated pain management programs improved both pain and function in patients with chronic pain at some — but not all — time frames, compared with usual care or waitlist
• Comprehensive pain management programs improved function at multiple time frames and pain immediately after the program, compared with usual care
• Comprehensive programs improved function and pain at multiple time frames, compared with medicine alone
• Comprehensive programs were associated with improvement in function in the short term compared with physical activity alone, but not in the intermediate or long term. There was no improvement in pain at any time point.
• There were no differences in pain or function between comprehensive programs and psychological support alone at any time
• Beneficial effects were usually considered small to moderate for both program types

Although evidence was limited, serious harms were not reported for either program. Formal pain management programs have not been widely implemented in the United States for either general populations or the Medicare population.