Identifying Teaming in Chronic Pain Management Interventions in Primary Care: A Systematic Review

Abstract

Background: Current pain management recommendations emphasize leveraging interdisciplinary care models, which rely on communication, coordination, and collaboration (i.e., teaming) among multiple providers. We aimed to identify key features of interdisciplinary teaming structures and processes that facilitate improved pain outcomes for patients experiencing chronic pain in primary care settings. Methods: We searched PubMed, EMBASE, CINAHL, and the Cochrane Library for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (i.e., BPI total pain), include primary care as an intervention setting, and demonstrate sufficient evidence of teaming (i.e., ongoing collaboration, coordination, or communication processes among providers and with patients). We assessed study quality with the Cochrane Risk of Bias tool. We qualitatively synthesized intervention characteristics related to teaming processes and categorized findings by positive or negative patient-reported pain outcomes. Results: We included 13 randomized studies with 14 total interventions in our review, of which 7 reported one or more significantly improved pain outcome compared to controls over 6 to 12 months of observation. No included studies had a high risk of bias. Interventions with positive pain outcomes often described regularly scheduled patient contact, but there were few identified similarities about the communication, coordination, and collaboration processes among intervention providers. Care management and patient follow-up schedules were identified as key characteristics of teaming in the interventions associated with improved pain outcomes. Discussion: Despite widespread emphasis on interdisciplinary teams for pain management, high quality evidence about relevant teaming structures and processes remains limited.