Multidisciplinary care for opioid dose reduction in patients with chronic non-cancer pain: A systematic realist review

Abstract

Context Opioid related deaths are at epidemic levels in many developed nations globally. Concerns about the contribution of prescribed opioids, and particularly high-dose opioids, continue to mount as do initiatives to reduce prescribing. Evidence around opioid tapering, which can be challenging and potentially hazardous, is not well developed. A recent national guideline has recognized this and recommended referral to multidisciplinary care for challenging cases of opioid tapering. However, multidisciplinary care for opioid tapering is not well understood or defined. Objective Identify the existing literature on any multidisciplinary care programs that evaluate impact on opioid use, synthesize how these programs work and clarify whom they benefit. Study design Systematic rapid realist review.

Time series-based bibliometric analysis of a systematic review of multidisciplinary care for opioid dose reduction: exploring the origins of the North American opioid crisis

“…We had two orders of data. The first order data were the 95 studies collected in our systematic realist review (Sud et al, 2020 ). The second order data were the set of publications that cited any one of these 95 studies.…”

“…To help clarify the guidance around what constitutes MDC for opioid dose reduction, how these programs are constituted and how they might be expected to work, we conducted a realist systematic review of MDC for opioid dose reduction (Sud et al, 2020 ). Through our multi-pronged, systematic search strategy, we identified 95 English-language evaluations of MDC programs for people living with chronic noncancer pain that reported opioid dose outcomes.…”

The impact of introducing multidisciplinary care assessments on access to rheumatology care in British Columbia: an interrupted time series analysis

“…Multidisciplinary care (MDC) teams are increasingly recognized as a potentially beneficial model of care for a myriad of conditions and contexts. This includes primary care, diabetes management, dermatology, cancer, chronic kidney disease, non-cancer pain management, stroke survivors, and rheumatology among others [1][2][3][4][5][6][7][8]. While many evaluations of MDC indicate encouraging results for quality of care and clinical outcomes [2][3][4][5]8], research into MDC is complicated by the diversity of contexts and variations across intervention models [1,9].…”

A Conceptual Framework for Continuing Medical Education and Population Health

“…28,29 As we have noted elsewhere, increases in years of life lost through drug overdoses have also been noted in countries such as the United Kingdom (UK), Australia, Sweden, and Finland. 30,31 Likewise, besides high-income North America, the regions of Eastern Europe, Australasia, North Africa, and the Middle East have a significantly higher age-standardized prevalence of opioid use disorder compared to the global estimate. 32 There have been a wide variety of policies addressing this epidemic, many of which have focused on prescribing.…”