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Multidisciplinary Treatment Programs for Patients with Chronic Non-Malignant Pain: A Review of Clinical Effectiveness, Cost-effectiveness, and Guidelines – An Update

Last updated: May 10, 2019
Project Number: RC1110-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of multidisciplinary treatment programs for patients with chronic, non-malignant pain in outpatient settings?
  2. What is the cost-effectiveness of multidisciplinary treatment programs for patients with chronic, non-malignant pain in outpatient settings?
  3. What are the evidence-based guidelines regarding multidisciplinary treatment programs for patients with chronic, non-malignant pain in outpatient settings?

Key Message

Two systematic reviews, two randomized controlled trials, and one economic evaluation regarding multidisciplinary treatment programs for patients with chronic, non-malignant pain in outpatient settings were included. No relevant evidence-based guidelines were identified. Overall, findings from the included studies suggest that the multidisciplinary management of chronic non-malignant pain is associated with significant improvements in pain intensity, and may be associated with significant improvements in quality of life and function. There was substantial variation in the types of multidisciplinary treatment programs and control interventions among studies. This suggests that various combinations of individual components in multidisciplinary programs may result in effective pain management. Findings from one economic evaluation suggested that the cost-effectiveness of multidisciplinary pain management programs is uncertain. The difference in quality-adjusted life-years between multidisciplinary treatment and control treatment was not statistically meaningful, and the higher costs associated with multidisciplinary treatment of patients with chronic low back pain resulted in an incremental cost-effectiveness ratio exceeding standard willingness-to-pay thresholds. Findings from the current report are consistent with those from the 2017 CADTH Rapid Response report.2 Evidence regarding optimal pain management services suggests that there is a benefit from moving beyond the only use of medication to more comprehensive programs. However, further research is needed to identify the type of components and combinations that would provide optimal benefits for patients with chronic pain.