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Effectiveness of Pharmacist-led Medication Review in Chronic Pain Management: Systematic Review and Meta-analysis

Hadi, Muhammad A. BPharm, MPharm (Clinical)*,†; Alldred, David P. PhD; Briggs, Michelle PhD§; Munyombwe, Theresa MSc; Closs, S. José PhD

doi: 10.1097/AJP.0000000000000063
Original Article

Objective: To evaluate the effectiveness of pharmacist-led medication review in chronic pain management.

Materials and Methods: Six electronic databases (Medline, Embase, PsycInfo, CINHAL, CENTRAL, International Pharmaceutical Abstracts) reference lists of retrieved articles and relevant websites were searched for randomized controlled trials 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 5 randomized controlled trials. Compared with 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 at 3 months [95% confidence interval (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 Osteoarthritis Index at 3 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 that limits recommendation of wider clinical role of pharmacist in chronic pain management.

*Discipline of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia

School of Healthcare

Center for Epidemiology & Biostatistics, University of Leeds

§Institute of Health and Well Being, Leeds Metropolitan University, Leeds

Bradford School of Pharmacy, University of Bradford, Bradford, United Kingdom

The authors declare no conflict of interest.

Reprints: Muhammad A. Hadi, BPharm, MPharm (Clinical), Discipline of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 46150, Malaysia (e-mails:;

Received April 14, 2013

Received in revised form December 30, 2013

Accepted December 3, 2013

© 2014 by Lippincott Williams & Wilkins