Stepped Care Models for Chronic Pain

Key Messages

• CADTH included 6 reports describing the potential clinical benefits of 5 stepped care models for chronic pain in this review.
  • The randomized controlled trial of the stepped care model for patients who are overweight or obese with chronic pain due medial tibiofemoral osteoarthritis described the impact on pain remission, pain intensity, and function.
  • The before-after and retrospective cohort study of the Stepped Care Model of Pain Management described the effects on pain, quality of chronic pain care, pharmacotherapy use, and health care utilization in US veterans.
  • The before-after study of the biopsychosocial stepped care model for non-cardiac chest pain described the potential benefits on chest pain, depression, anxiety, quality of life, and health care use.
  • The prospective cohort study of the Stepped Care Strategy compared a cohort of patients who received stepped care strategy-consistent care for hip or knee pain due to osteoarthritis with a cohort who received stepped care strategy-inconsistent care and described the results on pain physical function, self-efficacy, active pain coping, and health care use.
  • The Evaluation of Stepped Care for Chronic Pain randomized controlled trial described the effects on pain, disability, and pharmacotherapy use in US veterans.
• CADTH included 1 cost-effectiveness analysis that described the cost implications of a stepped care pathway for treating sciatica pain.
• While all included models used a stepped care approach to chronic pain management, the models were customized, and the evaluation methods were heterogeneous.