Organizational changes lead to a reduction in opioid consumption among chronic pain patients: A systematic review.

Abstract

To investigate the literature in terms of describing new ways to organize pain treatment for patients with chronic nonmalignant pain and the effect on opioid consumption. A systematic literature search was conducted in PubMed, CINAHL, REHABDATA, PsycINFO, and EMBASE using the methodology recommended by Cochrane. The data extraction was performed by Population, Intervention, Comparison, Outcome, and Time frame. The quality of the studies was rated by the Study Quality Assessment Tool or the revised Standards for Quality Improvement Reporting Excellence when suitable. Primary care clinics. Patients with chronic nonmalignant pain in high-dose opioid treatment connected to a primary care clinic or the employed healthcare professionals. The primary aim of this Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was to investigate if an organizational change in the follow-up procedures has an effect on high-dose opioid consumption in patients with long-term nonmalignant pain. Out of 2,146 articles, 11 studies met the inclusion criteria, mainly of an observational character. The majority of the studies were rated as good quality studies. As for the risk of bias, five studies were rated unclear, one study rated as high risk, and four studies as low risk of bias. One study could not be rated. All studies demonstrated a reduction in opioid consumption. Two studies investigated patients' pain and quality of life, but no reduction was found between groups. The findings indicate that it is possible to detect a reduction in opioid consumption when a new follow-up procedure has been implemented.