Assessing chronic pain in general practice: Are guidelines relevant? A cluster randomized controlled trial

Huas, Dominique; Pouchain, Denis; Avouac, Bernard; Bouvenot, G

doi:10.1080/13814780600872861

Cited by 9 publications

(4 citation statements)

References 10 publications

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“…A systematic preference for qualitative approaches among individual practitioners could lead to discounting of the large body of therapeutic knowledge derived, for example, from randomized controlled trials published in the scientific literature. Conversely, over-reliance on the use of quantitative measurements in day-to-day clinical practice has been thought to potentially contribute to negative patient perceptions of outcomes [ 46 ]. One interpretation of this finding is that the use of a quantitative measurement could facilitate the disengagement of the physician from the doctor-patient relationship and from the patient’s psychological suffering.…”

Section: Discussionmentioning

confidence: 99%

The place of words and numbers in psychiatric research

Falissard

Révah

Yang

et al. 2013

Philos Ethics Humanit Med

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In recent decades, there has been widespread debate in the human and social sciences regarding the compatibility and the relative merits of quantitative and qualitative approaches in research. In psychiatry, depending on disciplines and traditions, objects of study can be represented either in words or using two types of mathematization. In the latter case, the use of mathematics in psychiatry is most often only local, as opposed to global as in the case of classical mechanics. Relationships between these objects of study can in turn be explored in three different ways: 1/ by a hermeneutic process, 2/ using statistics, the most frequent method in psychiatric research today, 3/ using equations, i.e. using mathematical relationships that are formal and deterministic. The 3 ways of representing entities (with language, locally with mathematics or globally with mathematics) and the 3 ways of expressing the relationships between entities (using hermeneutics, statistics or equations) can be combined in a cross-tabulation, and nearly all nine combinations can be described using examples. A typology of this nature may be useful in assessing which epistemological perspectives are currently dominant in a constantly evolving field such as psychiatry, and which other perspectives still need to be developed. It also contributes to undermining the overly simplistic and counterproductive beliefs that accompany the assumption of a Manichean “quantitative/qualitative” dichotomy. Systematic examination of this set of typologies could be useful in indicating new directions for future research beyond the quantitative/qualitative divide.

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Section: Discussionmentioning

confidence: 99%

The place of words and numbers in psychiatric research

Falissard

Révah

Yang

et al. 2013

Philos Ethics Humanit Med

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“…In our Centre, we are currently studying whether change can be introduced into the language of the GP’s initial consultation with joint pain consulters and whether nurses can provide more in-depth support for self-management of joint pain or occupational rehabilitation for back pain patients. Other studies have investigated methods of training GPs in assessing pain as a multidimensional problem (Huas et al ., 2006) or whether other health professionals have more success in rehabilitation than doctors who concentrate exclusively on clinical aspects (eg, Shaw et al ., 2006).…”

Section: Shifting the Organisation Of Care: From Gp To ‘The Musculoskmentioning

confidence: 99%

Primary care research and musculoskeletal medicine

Croft

Peat

Windt

2009

Primary Health Care

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Musculoskeletal symptoms are frequent in primary care, and back pain and osteoarthritis are the commonest causes of disability in the developed world. Effective primary care could make a real difference to population levels of pain and disability. Traditional approaches, which see musculoskeletal pain only as a guide to underlying pathology, underestimate the need to assess and manage pain and disability in their own right. This paper presents the rationale for new models of diagnosis and care. These include: placing symptoms and their impact on daily life at the centre of primary care management of common musculoskeletal syndromes; a focus on the person with co-morbidity rather than on neatly parcelled distinctive single musculoskeletal diagnoses; promotion of positive messages such as the safety of activity and the efficacy of simple treatments; inclusion of the psychological and social context in management of musculoskeletal conditions; supporting patients to live and participate in daily life despite their pain or disability; supporting and training health care professionals other than doctors to provide a 'gatekeeping' role for these conditions; evaluation of changes in the organisation of care for patients with musculoskeletal problems. Evidence for the effectiveness of such new models is uneven. The paper reviews other research directions, such as qualitative research into patient perceptions and priorities, and the idea that non-specific treatment effects (eg, acupuncture) are often bigger than specific effects and could be harnessed to improve clinical care. Natural history studies remain important for understanding causation: prevalence is already near lifetime maximum by young adulthood for example and we do not know why. Musculoskeletal medicine is the Cinderella of primary care and primary care research. Knowledge, training and enthusiasm lags behind other priority areas for primary care clinicians. Yet the potential benefits, which primary care could achieve, are enormous.

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“…Pour identifier la (les) cible(s) pharmacologique(s) potentielle(s), il peut être nécessaire de mettre en oeuvre des techniques sophistiquées, faisant appel à la génomique, la transcriptomique, l'imagerie fonctionnelle, l'électrophysiologie, aux dosages de neuromédiateurs... qui devront être adaptés à chaque probléma-tique scientifique. Cette démarche est essentielle dans les essais explicatifs réalisés sur des échantillons de patients de taille modeste (n < 100) [24], elle est également à la base des essais en « grappes » (clusters) qui ont pour objectif d'analyser les réponses aux traitements dans des sousensembles plus homogènes de malades [9,11,14].…”

Section: Développer Des Tests Permettant D'explorer Les Mécanismes Phunclassified

Do clinical trials of analgesic drugs expect the emergence of innovative methodologies?

Dubray

2007

Douleur analg.

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Les cliniciens rencontrent de nombreuses difficultés pour mettre en évidence et quantifier l'effet analgésique des nouvelles molécules. Une des principales explications à ces échecs est le décalage entre le développement de molécules agissant sur des cibles pharmacologiques très spécifiques et l'hétérogénéité des mécanismes physiopathologiques impliqués dans la douleur. Les méthodes visant à atténuer les facteurs de variabilité dans les réponses aux traitements peuvent améliorer la puissance des essais cliniques. Une autre piste consiste à sélectionner les patients sur des critères qui ont une réelle pertinence pharmacologique. Cette approche peut avoir des retombées positives dans l'individualisation des traitements.Abstract: Over the past fifteen years, clinicians have faced many challenges in quantifying the analgesic properties of new compounds in clinical trials. One of the main explanations of failures is the gap between highly specific pharmacological targets and the heterogeneity of pathophysiological manifestations in patients suffering from painful diseases. Reducing the number of variables that represent sources of pain can improve clinical trials and the development of analgesics. Another step to improve the power of clinical trials is the creation of inclusion criteria that have genuine pharmacological relevance. Such an approach would also help physicians in their daily practice.

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Assessing chronic pain in general practice: Are guidelines relevant? A cluster randomized controlled trial

Cited by 9 publications

References 10 publications

The place of words and numbers in psychiatric research

The place of words and numbers in psychiatric research

Primary care research and musculoskeletal medicine

Do clinical trials of analgesic drugs expect the emergence of innovative methodologies?

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