Table 3.
Chronic Pain Care Model Processes
| Author and Year | Decision support | Increasing access to and coordination of multimodal care | Additional care coordination resources | Active patient education, activation |
|---|---|---|---|---|
| Ahles 2001/200623, 24 | Algorithm-guided treatment recommendations; nurse educator support for patients with psychosocial problems | Weekly telephone contact with nurse educator | ||
| Angeles 201325 | Centralization: multidisciplinary program developed by available providers, tailored to setting, delivered by group visits | Group sessions | ||
| Bair 20152 (ESCAPE) | Algorithm-guided stepped carea with analgesics and CBT, delivered by NCM | Biweekly by NCM | ||
| Burnham 201026 (CAPRI) | 4 care pathways based on complexity: (1) self-management, (2) spinal block, (3) medication management, (4) multidisciplinary care | Establishment of a multidisciplinary program in a rural setting | Weekly for complex patients | Weekly 5-h group multidisciplinary sessions for complex patients |
| Dobscha 200927 (SEACAP) |
Clinician education; stepped carea; expert decision support | Every 2 months by psychologist and internist team | Optional 4-session group workshop | |
| Hay 200628 | Enhanced pharmacy review: pharmacist-led and algorithm-guided | Biweekly by pharmacist and nurse | 3–6 20-min sessions with pharmacist | |
| Hill 201129 (STarT Back) | Risk stratification using validated tool; risk-matched treatment pathways | |||
| Kroenke 200930 (SCAMP) | Algorithm-guided stepped carea with antidepressants and self-management | Biweekly to monthly by depression pain clinical specialist | 6 30-min sessions with NCM | |
| Kroenke 201431 (SCOPE) | Algorithm-guided stepped carea with analgesics | Automated monitoring via IVR or internet that would prompt nurse contacts |
aStepped care refers to the sequential progression of treatment intensiveness according to an algorithm. For example, step 1 may involve self-management strategies alone and subsequent steps involving adding medications from first-line analgesic medications up to adding long-acting opioids
Abbreviations: NCM nurse case manager, CBT cognitive behavioral therapy, IVR interactive voice response, ESCAPE Evaluation of Stepped Care for Chronic Pain, SEACAP Study of the Effectiveness of a Collaborative Approach to Pain, SCAMP Stepped Care for Affective Disorders and Musculoskeletal Pain, SCOPE Stepped Care to Optimize Pain Care Effectiveness, CAPRI Central Alberta Pain and Rehabilitation Institute