TY - JOUR
AU - E. E. Krebs
AU - W. C. Becker
AU - D. B. Nelson
AU - B. M. DeRonne
AU - A. C. Jensen
AU - A. M. Kats
AU - B. J. Morasco
AU - J. W. Frank
AU - U. E. Makris
AU - K. D. Allen
AU - J. C. Naylor
AU - A. S. Mixon
AU - A. Bohnert
AU - T. E. Reznik
AU - J. T. Painter
AU - T. J. Hudson
AU - H. J. Hagedorn
AU - J. K. Manuel
AU - B. Borsari
AU - N. Purcell
AU - P. Hammett
AU - E. C. Amundson
AU - R. D. Kerns
AU - M. R. Barbosa
AU - C. Garvey
AU - E. J. Jones
AU - M . Y. Noh
AU - J. B. Okere
AU - S. Bhushan
AU - J. Pinsonnault
AU - B. E. Williams
AU - E. Herbst
AU - P. Lagisetty
AU - S. Librodo
AU - P. S. Mapara
AU - E. Son
AU - C. Tat
AU - R. A. Marraffa
AU - R. L. Seys
AU - C. Baxley
AU - K. H. Seal
A1 - 
AB - IMPORTANCE: Patients prescribed long-term opioid therapy for chronic pain often experience unrelieved pain, poor quality of life, and serious adverse events. OBJECTIVE: To compare the effects of integrated pain team (IPT) vs pharmacist collaborative management (PCM) on pain and opioid dosage. DESIGN, SETTING, AND PARTICIPANTS: This study was a pragmatic multisite 12-month randomized comparative effectiveness trial with masked outcome assessment. Patients were recruited from October 2017 to March 2021; follow-up was completed June 2022. The study sites were Veterans Affairs primary care clinics. Eligible patients had moderate to severe chronic pain despite long-term opioid therapy (≥20 mg/d for at least 3 months). INTERVENTIONS: IPT involved interdisciplinary pain care planning, visits throughout 12 months with medical and mental health clinicians, and emphasis on nondrug therapies and motivational interviewing. PCM was a collaborative care intervention involving visits throughout 12 months with a clinical pharmacist care manager who conducted structured monitoring and medication optimization. Both interventions provided individualized pain care and opioid tapering recommendations to patients. MAIN OUTCOMES AND MEASURES: The primary outcome was pain response (≥30% decrease in Brief Pain Inventory total score) at 12 months. The main secondary outcome was 50% or greater reduction in opioid daily dosage at 12 months. RESULTS: A total of 820 patients were randomized to IPT (n = 411) or PCM (n = 409). Participants' mean (SD) age was 62.2 (10.6) years, and 709 (86.5%) were male. A pain response was achieved in 58/350 patients in the IPT group (16.4%) vs 54/362 patients in the PCM group (14.9%) (odds ratio, 1.11 [95% CI, 0.74-1.67]; P = .61). A 50% opioid dose reduction was achieved in 102/403 patients in the IPT group (25.3%) vs 98/399 patients in the PCM group (24.6%) (odds ratio, 1.03 [95% CI, 0.75-1.42]; P = .85). Over 12 months, the mean (SD) Brief Pain Inventory total score improved from 6.7 (1.5) points to 6.1 (1.8) points (P < .001) in IPT and from 6.6 (1.6) points to 6.0 (1.9) points (P < .001) in PCM (between-group P = .82). Over 12 months, mean (SD) opioid daily dosage decreased from 80.8 (74.2) mg/d to 54.2 (65.0) mg/d in IPT (P < .001) and from 74.5 (56.9) mg/d to 52.8 (51.9) mg/d (P < .001) in PCM (between-group P = .22). CONCLUSIONS AND RELEVANCE: Outcomes in this randomized clinical trial did not differ between groups; both had small improvements in pain and substantial reductions in opioid dosage. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03026790.
AD - Minneapolis VA Health Care System, Minneapolis, Minnesota.; Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis.; VA Connecticut Healthcare System, West Haven.; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Medicine, University of Minnesota Medical School, Minneapolis.; Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis.; VA Portland Health Care System, Portland, Oregon.; Department of Psychiatry, Oregon Health & Science University, Portland.; VA Eastern Colorado Health Care System, Aurora.; Division of General Internal Medicine, University of Colorado School of Medicine, Aurora.; VA North Texas Health Care System, Dallas.; Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas.; Durham VA Health Care System, Durham, North Carolina.; Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill.; Department of Psychiatry and Behavioral Sciences Duke University School of Medicine, Durham, North Carolina.; VA Tennessee Valley Healthcare System, Nashville.; Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.; Ann Arbor VA Health Care System, Ann Arbor, Michigan.; Department of Anesthesiology, University of Michigan, Ann Arbor.; VA Providence Health Care System, Providence, Rhode Island.; VA Central Arkansas Health Care System, Little Rock.; Division of Pharmaceutical Evaluation & Policy, University of Arkansas for Medical Sciences, Little Rock.; Department of Emergency Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock.; Department of Psychiatry, University of Minnesota Medical School, Minneapolis.; San Francisco VA Health Care System, San Francisco, California.; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco.; Department of Social and Behavioral Sciences, University of California, San Francisco.; Department of Psychiatry, Yale University, New Haven, Connecticut.; Department of Medicine, University of Texas Southwestern Medical Center, Dallas.; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.; VA Northern California Healthcare System, Mather.; Duke University School of Medicine, Durham, North Carolina.; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.; Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland.; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.; Department of Pharmacy, University of California, San Francisco.; Department of Psychiatry, University of California, San Francisco.; VA Washington DC Health Care System.; VA Northern California Health Care System, Mather.; Division of Pharmacy Practice and Experiential Education, University of North Carolina School of Pharmacy, Chapel Hill.; Department of Medicine, University of California, San Francisco.
AN - 39652356
BT - JAMA Intern Med
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 2
DA - Feb 1
DO - 10.1001/jamainternmed.2024.6683
DP - NLM
IS - 2
JF - JAMA Intern Med
LA - eng
N2 - IMPORTANCE: Patients prescribed long-term opioid therapy for chronic pain often experience unrelieved pain, poor quality of life, and serious adverse events. OBJECTIVE: To compare the effects of integrated pain team (IPT) vs pharmacist collaborative management (PCM) on pain and opioid dosage. DESIGN, SETTING, AND PARTICIPANTS: This study was a pragmatic multisite 12-month randomized comparative effectiveness trial with masked outcome assessment. Patients were recruited from October 2017 to March 2021; follow-up was completed June 2022. The study sites were Veterans Affairs primary care clinics. Eligible patients had moderate to severe chronic pain despite long-term opioid therapy (≥20 mg/d for at least 3 months). INTERVENTIONS: IPT involved interdisciplinary pain care planning, visits throughout 12 months with medical and mental health clinicians, and emphasis on nondrug therapies and motivational interviewing. PCM was a collaborative care intervention involving visits throughout 12 months with a clinical pharmacist care manager who conducted structured monitoring and medication optimization. Both interventions provided individualized pain care and opioid tapering recommendations to patients. MAIN OUTCOMES AND MEASURES: The primary outcome was pain response (≥30% decrease in Brief Pain Inventory total score) at 12 months. The main secondary outcome was 50% or greater reduction in opioid daily dosage at 12 months. RESULTS: A total of 820 patients were randomized to IPT (n = 411) or PCM (n = 409). Participants' mean (SD) age was 62.2 (10.6) years, and 709 (86.5%) were male. A pain response was achieved in 58/350 patients in the IPT group (16.4%) vs 54/362 patients in the PCM group (14.9%) (odds ratio, 1.11 [95% CI, 0.74-1.67]; P = .61). A 50% opioid dose reduction was achieved in 102/403 patients in the IPT group (25.3%) vs 98/399 patients in the PCM group (24.6%) (odds ratio, 1.03 [95% CI, 0.75-1.42]; P = .85). Over 12 months, the mean (SD) Brief Pain Inventory total score improved from 6.7 (1.5) points to 6.1 (1.8) points (P < .001) in IPT and from 6.6 (1.6) points to 6.0 (1.9) points (P < .001) in PCM (between-group P = .82). Over 12 months, mean (SD) opioid daily dosage decreased from 80.8 (74.2) mg/d to 54.2 (65.0) mg/d in IPT (P < .001) and from 74.5 (56.9) mg/d to 52.8 (51.9) mg/d (P < .001) in PCM (between-group P = .22). CONCLUSIONS AND RELEVANCE: Outcomes in this randomized clinical trial did not differ between groups; both had small improvements in pain and substantial reductions in opioid dosage. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03026790.
PY - 2025
SN - 2168-6106 (Print); 2168-6106
SP - 208
EP - 220+
ST - Care Models to Improve Pain and Reduce Opioids Among Patients Prescribed Long-Term Opioid Therapy: The VOICE Randomized Clinical Trial
T1 - Care Models to Improve Pain and Reduce Opioids Among Patients Prescribed Long-Term Opioid Therapy: The VOICE Randomized Clinical Trial
T2 - JAMA Intern Med
TI - Care Models to Improve Pain and Reduce Opioids Among Patients Prescribed Long-Term Opioid Therapy: The VOICE Randomized Clinical Trial
U1 - Healthcare Disparities; Opioids & Substance Use
U3 - 10.1001/jamainternmed.2024.6683
VL - 185
VO - 2168-6106 (Print); 2168-6106
Y1 - 2025
ER -