Chronic Pain as an Individual Disease: A Patient-tailored Approach in Clinical Practice

“Real-world evidence (RWE)” is becoming increasingly important in order to integrate the results of randomized studies into everyday clinical practice. The data collection of RWE is usually derived from large-scale national and international registries, often driven by academic centers. We have developed a digitalized doctor–patient platform called DESTINY (DatabasE-assiSted Therapy decIsioN support sYstem) that is utilized by NeuroTransData (NTD), a network of neurologists and psychiatrists throughout Germany. This platform can be integrated into everyday practice and, as well as being used for scientific evaluations in healthcare research, can also serve as an individual, personalized treatment application. Its various modules allow for a timely identification of side-effects or interactions of treatments, can involve patients via the “My NTC Health Guide” portal, and can collect data of individual disease histories that are integrated into innovative algorithms, e.g., for the prediction of treatment response [currently available for multiple sclerosis (MS), with other indications in the pipeline]. Here, we describe the doctor–patient platform DESTINY for outpatient neurological practices and its contribution to improved treatment success as well as reduction of healthcare costs. Platforms like DESTINY may facilitate the goal of personalized healthcare.

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Hypnosis and relaxation

Oxford Textbook of Paediatric Pain ◽

10.1093/med/9780199642656.003.0054 ◽

2013 ◽

pp. 560-568 ◽

Cited By ~ 1

Author(s):

Christina Liossi ◽

Leora Kuttner ◽

Chantal Wood ◽

Lonnie K. Zeltzer

Keyword(s):

Chronic Pain ◽

Clinical Practice ◽

Pain Management ◽

Research Evidence ◽

Research Literature ◽

Current Understanding ◽

Relaxation Techniques ◽

Chronic Pain Management ◽

Future Studies ◽

Hypnotic Analgesia

This chapter discusses the current research literature and clinical practice regarding the use of hypnosis in paediatric pain management, first defining hypnosis and discussing theoretical conceptualizations. Next it presents our current understanding of the mechanisms of hypnotic analgesia, along with the research evidence for the efficacy of hypnosis in the control of acute and chronic paediatric pain; in both sections relevant clinical techniques are discussed. It also includes a description and discussion of different relaxation techniques and the evidence for their efficacy in acute and chronic pain management, and concludes with an attempt to summarize and evaluate the existing literature and make suggestions for future studies and clinical practice.

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Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice

BMJ ◽

10.1136/bmj.m1668 ◽

2020 ◽

pp. m1668 ◽

Cited By ~ 1

Author(s):

Ted J Kaptchuk ◽

Christopher C Hemond ◽

Franklin G Miller

Keyword(s):

Chronic Pain ◽

Clinical Practice ◽

Predictive Coding ◽

Evidence Theory ◽

Placebo Treatment ◽

Placebo Effects ◽

Unified Framework ◽

Open Label ◽

Double Blind ◽

Bayesian Brain

ABSTRACTDespite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights “predictive coding” and “bayesian brain” as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.

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Pharmacogenetic Testing: The Ethics of Implementing in Clinical Practice for Chronic Pain Patients

Journal of Pain & Palliative Care Pharmacotherapy ◽

10.1080/15360288.2019.1707929 ◽

2020 ◽

Vol 34 (2) ◽

pp. 69-76

Author(s):

Karin M. Fredrikson ◽

Tracy Fasolino

Keyword(s):

Chronic Pain ◽

Clinical Practice ◽

Pharmacogenetic Testing ◽

Chronic Pain Patients ◽

Pain Patients

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What are the similarities and differences between healthy people with and without pain?

Scandinavian Journal of Pain ◽

10.1515/sjpain-2017-0156 ◽

2018 ◽

Vol 18 (1) ◽

pp. 39-47

Author(s):

Jennifer N. Baldwin ◽

Marnee J. McKay ◽

Joshua Burns ◽

Claire E. Hiller ◽

Elizabeth J. Nightingale ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Risk Factors ◽

Chronic Pain ◽

Clinical Practice ◽

Self Efficacy ◽

Effect Sizes ◽

Healthy Individuals ◽

Sit To Stand ◽

Clinically Significant

Abstract Background and aims: Knowledge of pain characteristics among the healthy population or among people with minimal pain-related disability could hold important insights to inform clinical practice and research. This study investigated pain prevalence among healthy individuals and compared psychosocial and physical characteristics between adults with and without pain. Methods: Data were from 1,000 self-reported healthy participants aged 3–101 years (1,000 Norms Project). Single-item questions assessed recent bodily pain (“none” to “very severe”) and chronic pain (pain every day for 3 months in the previous 6 months). Assessment of Quality of Life (AQoL) instrument, New Generalised Self-Efficacy Scale, International Physical Activity Questionnaire, 6-min walk test, 30-s chair stand and timed up-and-down stairs tests were compared between adults with and without pain. Results: Seventy-two percent of adults and 49% of children had experienced recent pain, although most rated their pain as mild (80% and 87%, respectively). Adults with recent pain were more likely to be overweight/obese and report sleep difficulties, and had lower self-efficacy, AQoL mental super dimension scores and sit-to-stand performance, compared to adults with no pain (p<0.05). Effect sizes were modest (Cohen’s d=0.16–0.39), therefore unlikely clinically significant. Chronic pain was reported by 15% of adults and 3% of children. Adults with chronic pain were older, more likely to be overweight/obese, and had lower AQoL mental super dimension scores, 6-min walk, sit-to-stand and stair-climbing performance (p<0.05). Again, effect sizes were modest (Cohen’s d=0.25–0.40). Conclusions: Mild pain is common among healthy individuals. Adults who consider themselves healthy but experience pain (recent/chronic) display slightly lower mental health and physical performance, although these differences are unlikely clinically significant. Implications: These findings emphasise the importance of assessing pain-related disability in addition to prevalence when considering the disease burden of pain. Early assessment of broader health and lifestyle risk factors in clinical practice is emphasised. Avenues for future research include examination of whether lower mental health and physical performance represent risk factors for future pain and whether physical activity levels, sleep and self-efficacy are protective against chronic pain-related disability.

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Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2889-1 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Miguel A. Galán-Martín ◽

Federico Montero-Cuadrado ◽

Enrique Lluch-Girbes ◽

M. Carmen Coca-López ◽

Agustín Mayo-Iscar ◽

...

Keyword(s):

Public Health ◽

Quality Of Life ◽

Primary Care ◽

Chronic Pain ◽

Clinical Practice ◽

Physical Exercise ◽

Public Health System ◽

The Public ◽

Neuroscience Education

Abstract Background Chronic musculoskeletal pain affects more than 20% of the population, and the prevalence is increasing, causing suffering, loss of quality of life, disability, and an enormous expenditure on healthcare resources. The most common location for chronic pain is the spine. Many of the treatments used are mainly passive (pharmacological and invasive) and poor outcomes. The treatments currently applied in the public health system do not comply with the recommendations of the main clinical practice guidelines, which suggest the use of educational measures and physical exercise as the first-line treatment. A protocol based on active coping strategies is described, which will be evaluated through a clinical trial and which could facilitate the transfer of the recommendations of the clinical practice guidelines to a primary care setting. Methods Randomised and multicentre clinical trials, which will be carried out in 10 Primary Care centres. The trial will compare the effect of a Pain Neuroscience Education program (six sessions, 10 h) and group physical exercise (18 sessions program carried out in six weeks, 18 h), with usual care physiotherapy treatment. Group physical exercise incorporates dual tasks, gaming, and reinforcement of contents of the educational program. The aim is to assess the effect of the intervention on quality of life, as well as on pain, disability, catastrophism, kinesiophobia, central sensitisation, and drug use. The outcome variables will be measured at the beginning of the intervention, after the intervention (week 11), at six months, and a year. Discussion Therapeutic interventions based on active coping strategies are essential for the treatment of chronic pain and the sustainability of the Public Health System. Demonstrating whether group interventions have an effect size is essential for optimising resources in such a prevalent problem. Trial registration NCT03654235 “Retrospectively registered” 31 August 2018.

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