MANAGEMENT OF CHRONIC PAIN IN RESOURCE-LIMITED SETTINGS

A LITERATURE REVIEW OF EFFECTIVENESS, SAFETY, AND FEASIBILITY WITH AN EMPHASIS ON INDONESIA’S BPJS HEALTH COVERAGE

Abstract

Chronic pain disproportionately affects rural populations, where limited specialist access constrains multimodal care. We synthesized evidence on the effectiveness, safety, and feasibility of interventions suited to resource-limited settings, with emphasis on Indonesia’s BPJS context. Using a PICOS-based strategy, we searched PubMed, ScienceDirect, Cochrane, and ProQuest (2015–2025) and identified 13 studies (n=2,022) encompassing randomized trials, pragmatic cohorts, and feasibility pilots. Across settings, nonpharmacologic and multimodal approaches—peer-led self-management and group education, literacy-adapted cognitive-behavioral/digital coping programs, tele-enabled collaborative care, integrative medicine group visits, massage, exercise, and community or marine-based activity—consistently improved pain-related function and quality of life, often with reduced analgesic and opioid use. Evidence for pharmacologic-only approaches was limited. These findings support a stepped, non-drug-first model aligned with BPJS purchasing that prioritizes functional improvement and deprescribing. Evidence gaps—including limited data from low- and middle-income countries, heterogeneous endpoints, and short follow-up—justify pragmatic, hybrid effectiveness–implementation trials and claims-linked evaluations to confirm durability, equity, and cost-effectiveness and to guide scale-up in BPJS primary care.