Integrated Pain Management

Integrated Pain Management

In North Carolina, deaths due to medication/drug overdoses have been steadily increasing since 1999, and the vast majority (90%) of these are unintentional.[1] Many of the current approaches for combating the opioid crisis are reactive, such as prescription drug monitoring programs and prescribing guidelines for opioids. These efforts have resulted in lower opioid prescribing rates, but do not address the underlying problem of untreated pain. In the absence of appropriate pain relief and meaningful access to non-opioid alternatives, there is rising concern that these efforts are resulting in barriers to appropriate pain management and adverse consequences (e.g., overdose or suicide) for patients currently dependent on opioids.

Integrated pain management models, with pharmacologic/drug therapies, psychological/behavioral care, physical therapy, occupational therapy, and other services, can effectively address the burden of pain. While there is evidence for the effectiveness of these approaches, expanding use of such models requires identifying best practices for implementation.

As part of a larger portfolio of projects to reduce the harms of opioids in North Carolina, the Duke Department of Orthopaedic Surgery and the Duke-Margolis Center for Health Policy are launching the effort to better understand how integrated pain management models are being developed and implemented in health systems, and to identify how such models can be deployed more broadly throughout the state. Integrated pain management engages psychological/behavioral care, physical therapy, occupational therapy, and other services in addition to pain management prescription drugs. By focusing on and working to resolve untreated pain, integrated pain management approaches hold promise to provide lasting relief to patients while minimizing or eliminating the use of opioids.

This initiative will:

  1. Identify integrated pain management models that improve outcomes and reduce opioid-related risks,
  2. Describe organizations that have successfully undertaken this approach, and
  3. Recommend how to better implement these models in North Carolina and similar states.

Trevor Lentz, PT, PhD, MPH is the Principal Investigator for this project. It is considered a part of the Duke School of Medicine’s (SOM) Opioid Program portfolio, funded by the Duke Endowment, entitled “Improving Southern Health: Addressing the Opioid Crisis in North Carolina,” led by Asheley Skinner, PhD, Associate Professor in the Department of Population Health Sciences, and with executive support from Adrian Hernandez, MD, Vice Dean of Clinical Research. The study team, which also includes Rob Saunders, PhD, Isha Sharma, Jonathan Gonzalez-Smith, and Will Bleser from the Duke-Margolis Center for Health Policy, and Christine Goertz, DC, PhD from the Department of Orthopaedic Surgery, will work over an 18-month period in collaboration with the SOM Opioid Program Core Leadership Team and Steering Committee.

About the Duke-Margolis Center for Health Policy:

The Robert J. Margolis, MD, Center for Health Policy at Duke University is both an academic research center and a policy laboratory. Its mission is to improve health and the value of health care through practical, innovative, and evidence-based policy solutions. To learn more, please visit


About Duke Endowment (TDE) funded Opioid Program:

The Opioid Program, housed within the Duke University School of Medicine and administered through the Department of Population Health Sciences, is designed to save lives and reduce the harmful impact of opioids in North Carolina through the development, implementation, and/or evaluation of sustainable, system-level interventions.

Duke-Margolis Research Team

Trevor Lentz

Trevor Lentz, PhD

Assistant Professor in Orthopaedic Surgery
Margolis Core Faculty

rob saunders

Robert Saunders, PhD

Research Director, Health Care Transformation
Senior Team Member

isha sharma

Isha Sharma, MSC, MA

Senior Research Assistant

William K. Bleser - Margolis headhot

William K. Bleser, PhD, MSPH

Managing Associate, Payment Reform and Population Health
Senior Team Member