Core Outcome Sets and Multidimensional Assessment Tools for Harmonizing Outcome Measure in Chronic Pain and Back Pain

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

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Faculty Opinions recommendation of Chronic pain and the emotional brain: specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1057719.512905 ◽

2007 ◽

Author(s):

Allan Gottschalk

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Chronic Back Pain ◽

Brain Activity ◽

Spontaneous Fluctuations

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The process of conducting a multi-centre study to validate a core outcome measure in palliative care setings

Journal of Pain and Symptom Management ◽

10.1016/s0885-3924(98)80030-4 ◽

1998 ◽

Vol 15 (4) ◽

pp. S10

Author(s):

J Hearn

Keyword(s):

Palliative Care ◽

Outcome Measure ◽

Core Outcome ◽

Multi Centre Study ◽

Centre Study ◽

Core Outcome Measure

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Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression

Medicina ◽

10.3390/medicina57040327 ◽

2021 ◽

Vol 57 (4) ◽

pp. 327

Author(s):

Dominique Josephine Dimmek ◽

Christoph Korallus ◽

Sabine Buyny ◽

Gutenbrunner Christoph ◽

Ralf Lichtinghagen ◽

...

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Immune Cells ◽

Chronic Widespread Pain ◽

Anxiety And Depression ◽

Low Back ◽

Widespread Pain ◽

Chronic Pain Patients ◽

Pain Patients

Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3− CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3− CD56bright NK cells (p = 0.049) and CD20+ CD3− cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients.

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Estimating the population health burden of musculoskeletal conditions using primary care electronic health records

Rheumatology ◽

10.1093/rheumatology/keab109 ◽

2021 ◽

Author(s):

Dahai Yu ◽

George Peat ◽

Kelvin P Jordan ◽

James Bailey ◽

Daniel Prieto-Alhambra ◽

...

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Electronic Health Records ◽

High Impact ◽

Low Back ◽

Musculoskeletal Health ◽

Health Records ◽

Electronic Health

Abstract Objectives Better indicators from affordable, sustainable data sources are needed to monitor population burden of musculoskeletal conditions. We propose five indicators of musculoskeletal health and assessed if routinely available primary care electronic health records (EHR) can estimate population levels in musculoskeletal consulters. Methods We collected validated patient-reported measures of pain experience, function and health status through a local survey of adults (≥35 years) presenting to English general practices over 12 months for low back pain, shoulder pain, osteoarthritis and other regional musculoskeletal disorders. Using EHR data we derived and validated models for estimating population levels of five self-reported indicators: prevalence of high impact chronic pain, overall musculoskeletal health (based on Musculoskeletal Health Questionnaire), quality of life (based on EuroQoL health utility measure), and prevalence of moderate-to-severe low back pain and moderate-to-severe shoulder pain. We applied models to a national EHR database (Clinical Practice Research Datalink) to obtain national estimates of each indicator for three successive years. Results The optimal models included recorded demographics, deprivation, consultation frequency, analgesic and antidepressant prescriptions, and multimorbidity. Applying models to national EHR, we estimated that 31.9% of adults (≥35 years) presenting with non-inflammatory musculoskeletal disorders in England in 2016/17 experienced high impact chronic pain. Estimated population health levels were worse in women, older aged and those in the most deprived neighbourhoods, and changed little over 3 years. Conclusion National and subnational estimates for a range of subjective indicators of non-inflammatory musculoskeletal health conditions can be obtained using information from routine electronic health records.

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Cross-cultural adaptation and validation of the Polish version of the Core Outcome Measures Index for low back pain

European Spine Journal ◽

10.1007/s00586-012-2607-2 ◽

2012 ◽

Vol 22 (5) ◽

pp. 995-1001 ◽

Cited By ~ 15

Author(s):

Grzegorz Miekisiak ◽

Marta Kollataj ◽

Jan Dobrogowski ◽

Wojciech Kloc ◽

Witold Libionka ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Cultural Adaptation ◽

Cross Cultural ◽

Core Outcome ◽

Low Back ◽

Cross Cultural Adaptation ◽

The Core ◽

Polish Version ◽

Core Outcome Measures

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Engaging Stakeholders and Promoting Uptake of OMERACT Core Outcome Instrument Sets

The Journal of Rheumatology ◽

10.3899/jrheum.161273 ◽

2017 ◽

Vol 44 (10) ◽

pp. 1551-1559 ◽

Cited By ~ 13

Author(s):

Sean R. Tunis ◽

Lara J. Maxwell ◽

Ian D. Graham ◽

Beverley J. Shea ◽

Dorcas E. Beaton ◽

...

Keyword(s):

Knowledge Translation ◽

Core Outcome Set ◽

Healthcare Providers ◽

Stakeholder Involvement ◽

Decision Makers ◽

Core Outcome ◽

Core Outcome Sets ◽

Regulatory Decision ◽

Outcome Instrument ◽

Outcome Domain

Objective.While there has been substantial progress in the development of core outcomes sets, the degree to which these are used by researchers is variable. We convened a special workshop on knowledge translation at the Outcome Measures in Rheumatology (OMERACT) 2016 with 2 main goals. The first focused on the development of a formal knowledge translation framework and the second on promoting uptake of recommended core outcome domain and instrument sets.Methods.We invited all 189 OMERACT 2016 attendees to the workshop; 86 attended, representing patient research partners (n = 15), healthcare providers/clinician researchers (n = 52), industry (n = 4), regulatory agencies (n = 4), and OMERACT fellows (n = 11). Participants were given an introduction to knowledge translation and were asked to propose and discuss recommendations for the OMERACT community to (1) strengthen stakeholder involvement in the core outcome instrument set development process, and (2) promote uptake of core outcome sets with a specific focus on the potential role of post-regulatory decision makers.Results.We developed the novel “OMERACT integrated knowledge translation” framework, which formalizes OMERACT’s knowledge translation strategies. We produced strategies to improve stakeholder engagement throughout the process of core outcome set development and created a list of creative and innovative ways to promote the uptake of OMERACT’s core outcome sets.Conclusion.The guidance provided in this paper is preliminary and is based on the views of the participants. Future work will engage OMERACT groups, “post-regulatory decision makers,” and a broad range of different stakeholders to identify and evaluate the most useful methods and processes, and to revise guidance accordingly.

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