Objective: To evaluate the effectiveness of pharmacist-led medication review in chronic pain management.
Methods: Six electronic databases (Medline, Embase, PsycInfo, CINHAL, CENTRAL, International Pharmaceutical Abstracts) reference lists of retrieved articles and relevant websites were searched for randomised controlled trials (RCTs) published in the English language involving adults with chronic pain. Studies were included if one of the intervention arms had received pharmacist-led medication review independently or as part of a multidisciplinary intervention. Risk of bias was assessed for all the included studies.
Results: The search strategy yielded 583 unique articles including five RCTs. Compared to control, meta-analysis showed that participants in the intervention group had: a 0.8 point reduction in pain intensity on a 0 to 10 numerical rating scale (NRS) at 3-months (95% CI, -1.28 to -0.36) and a 0.7 point reduction (95% CI -1.19 to -0.20) at 6-months; a 4.84 point (95% CI, -7.38 to -2.29) and -3.82 point (95% CI, -6.49 to -1.14) improvement in physical functioning on a 0 to 68 point function subscale of Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 3-months and 6-months respectively; and a significant improvement in patient satisfaction equivalent to a "small to moderate effect."
Discussion: Pharmacist-led medication review reduces pain intensity and improves physical functioning and patient satisfaction. However, the clinical significance of these findings remain uncertain due to small effect size and nature of reported data within clinical trials which limits recommendation of wider clinical role of pharmacist in chronic pain management.
(C) 2014 by Lippincott Williams & Wilkins