Stepped care for chronic pain: a systematic review demonstrating the impact of IMPT in the final treatment stage

Background Although matched care is increasingly regarded as the more evidence-based approach for chronic musculoskeletal pain, reimbursement systems often require Interdisciplinary Multimodal Pain Treatment (IMPT) to be delivered as the final step in a stepped care approach to ensure transparent attribution of effects. This study therefore evaluates the effectiveness of IMPT specifically after preceding lower-intensity treatments. Methods Adult cohorts receiving IMPT after unsuccessful less-intensive treatments were included. Eligible studies reported >= 12-month follow-up. Standardised mean change (SMC) scores from pre-treatment to follow-up were synthesised for health-related quality of life (HRQoL), pain interference, physical functioning and pain intensity. Results Sixteen cohorts from 13 studies met criteria. Most showed positive long-term outcomes across all domains. Meta-analyses demonstrated significant moderate-to-strong improvements, over all outcome domains, despite substantial heterogeneity. Conclusions IMPT as the final stepped-care intervention provides consistent, clinically meaningful long-term benefits for chronic primary musculoskeletal pain, supporting its continued implementation and funding.