Michael Von Korff, ScD, has carried out groundbreaking research on the management and outcomes of chronic pain, depression, and other illnesses in primary care settings, emphasizing the role of patients in self-management of chronic illness. His work as an epidemiologist and health services researcher focuses on understanding how patients adapt to chronic illnesses associated with pain and psychological distress, including how they use health care services and medicines, and how they cope with illness in their daily lives.
Nationally known for his research on collaborative care for depression, Dr. Von Korff’s recent work has focused on trends and risks of long-term prescription of opioids for chronic non-cancer pain. In 2010, he and colleagues published the first study to link higher risk of fatal and nonfatal opioid overdoses to higher daily dose prescribed, leading federal officials to call for reduced opioid prescribing for chronic pain in the United States. Dr. Von Korff then worked with clinical leaders at Kaiser Permanente Washington to implement a multifaceted opioid safety initiative, which led to a 63 percent drop in the number of patients on high opioid doses. With funding from the Patient-Centered Outcomes Research Institute, Dr. Von Korff evaluated effects of these practice changes on patient pain outcomes and opioid-related adverse events, finding a one third reduction in opioid overdose rates with reductions in opioid dose, but no further change in overdose rates with more complex risk stratification and monitoring initiatives.
Dr. Von Korff is also working on the Team-Based Opioid Management project, which is funded by the Agency for Healthcare Research and Quality. The project provides a public website with dozens of resources and tools that support safer opioid prescribing. Its centerpiece is the “Six Building Blocks”—the core components of safe, team-based opioid prescribing that have been implemented successfully in primary care settings across the country.
Earlier in his career, Dr. Von Korff co-led a series of major randomized trials examining various approaches to chronic illness management in primary care, including collaborative care for depression and interventions to improve self-care of chronic-recurrent back pain. He co-led the research team that developed and evaluated the TeamCare program for patients with depression and poorly controlled diabetes or cardiovascular disease, which improved depression, diabetes, and cardiovascular disease outcomes.
A major focus throughout Dr. Von Korff’s career has been studying mental-physical comorbidity (illnesses co-occurring) and how patients manage bothersome and disabling physical symptoms. This research has included a series of longitudinal studies of disability and health care use among primary care patients with depression, back pain, headache, orofacial pain, and other chronic pain conditions. He proposed a stepped-care approach to back pain management subsequently adopted by Veterans Affairs in their initiatives to improve chronic pain care in their clinics. He also developed widely used methods for grading the severity of chronic pain in epidemiologic and health services research.
Dr. Von Korff co-founded Physicians for Responsible Opioid Prescribing, an organization that has effectively advocated nationally for more cautious and selective opioid prescribing. He has published more than 400 papers in peer-reviewed journals on chronic pain, mental health, chronic illness, and disability. In 2002, the Institute for Scientific Information recognized him as one of the nation’s most highly cited scientists in psychiatry and behavioral sciences. He has served as an advisor to major global mental health studies conducted by the World Health Organization (see one here, and another here). In 2013–2014, he chaired the Population Research Work Group for the federal government’s National Pain Strategy which developed methods for defining and identifying “high-impact chronic pain” subsequently used by the U.S. National Health Interview Survey for monitoring goals related to chronic pain set by Healthy People 2020. He is an affiliate professor of psychiatry at the University of Washington and served as KPWHRI’s associate director for research from 1992 to 1996 and again from 1999 to 2005.
Disability, health care use, disease management, symptom management, physical-mental comorbidity
Opioid safety, back pain, headache, orofacial pain
Depression; depression and chronic disease comorbidity
Health care and medication use
Self-management of chronic illness, illness behavior
Liu M, McCurry SM, Belza B, Buchanan DT, Dobra A, Von Korff M, Vitiello MV. Effects of pain, insomnia, and depression on psychoactive medication supply in older adults with osteoarthritis. Med Care. 2018 Sep 25. doi: 10.1097/MLR.0000000000000982. [Epub ahead of print]. PubMed
Balderson BH, Pruitt SD, Von Korff M. Strengthening self-management of low back pain in primary care: an evolving paradigm. In: Turk DC, Gatchel RJ, editors. Psychological Approaches to Pain Management: A Practitioner’s Handbook, 3rd Edition. New York: Guilford Press; 2018. p 319-339.
Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, Kerns R, Von Korff M, Porter L, Helmick C. Prevalence of chronic pain and high-impact chronic pain among adults -United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-1006. doi: 10.15585/mmwr.mm6736a2. PubMed
Von Korff M, Saunders K, Dublin S, Walker RL, Thakral M, Sherman KJ, Ludman EJ, Hansen RN, Parchman M, Shortreed SM. Impact of chronic opioid therapy risk reduction initiatives on opioid overdose. 2019 Jan;20(1):108-117. doi: 10.1016/j.jpain.2018.08.003. Epub 2018 Sep 3. PubMed
Pitcher MH, Von Korff M, Bushnell MC, Porter L. Prevalence and profile of high impact chronic pain in the United States. J Pain. 2019 Feb;20(2):146-160. doi: 10.1016/j.jpain.2018.07.006. Epub 2018 Aug 7. PubMed
Sherman KJ, Walker RL, Saunders K, Shortreed SM, Parchman M, Hansen RN, Thakral M, Ludman EJ, Dublin S, Von Korff M. Doctor-patient trust among chronic pain patients on chronic opioid therapy after opioid risk reduction initiatives: a survey. J Am Board Fam Med. 2018;31(4):578-587. doi: 10.3122/jabfm.2018.04.180021. PubMed
Dublin S, Von Korff M. Prescription Opioids and Infection Risk: Research and Caution Needed. Ann Intern Med. 2018;168(6):444-445. doi: 10.7326/M18-0001. Epub 2018 Feb 13. PubMed
Thakral M, Walker RL, Saunders K, Shortreed SM, Dublin S, Parchman M, Hansen RN, Ludman E, Sherman KJ, Von Korff M. Impact of opioid dose reduction initiatives on chronic opioid therapy patients at higher risk for opioid-related adverse outcomes. Pain Med. 2017 Dec 6. doi: 10.1093/pm/pnx293. [Epub ahead of print]. PubMed
Thakral M, Walker RL, Saunders K, Shortreed SM, Parchman M, Hansen RN, Ludman E, Sherman KJ, Dublin S, Von Korff M. Comparing pain and depressive symptoms of chronic opioid therapy patients receiving dose reduction and risk mitigation initiatives to usual care. J Pain. 2018 Jan;19(1):111-120. doi: 10.1016/j.jpain.2017.09.006. Epub 2017 Oct 13. PubMed
Koffel E, Vitiello MV, McCurry SM, Rybarczyk B, Von Korff M. Predictors of adherence to psychological treatment for insomnia and pain: analysis from a randomized trial. Clin J Pain. 2018 Apr;34(4):375-382. doi: 10.1097/AJP.0000000000000546. PubMed
The latest on our research on chronic pain and opioids—and how the results influence health policy and clinical practice.
Discovering better ways to care for people who are depressed or have chronic pain, one of KPWHRI’s founding scientists has helped change health care around the globe.
A conversation with KPWHRI’s Michael Von Korff, ScD, as he retires after 36 years of transformative health research
In Annals editorial Drs. Sascha Dublin and Michael Von Korff advocate more caution in prescribing these medications.