Different measures, different outcomes? Survey into the effectiveness of chronic pain clinics in a London tertiary referral center

Shah, Savan; Ho, Alexandra; Kuehler, Bianca M; Childs, Susan; Towlerton, Glyn; Goodall, Ian; Bantel, Carsten

doi:10.2147/jpr.s80829

Cited by 6 publications

(4 citation statements)

References 39 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, our results also show that numerical-spatial changes are present across different painful conditions, hence adding considerably to the evolving field of research into the cognitive consequences of CP. Further, the proposed association between number sense alterations and pain intensity measurements could be criticized for not acknowledging enough the complex nature of clinical pain assessment ( Shah et al, 2015 ). Although it is certainly true that a patient’s subjective pain rating is influenced by a variety of factors, number sense might still be an important contributor, a notion clearly supported here.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Chronic Pain and Cognitive Function on Spatial-Numerical Processing

Spindler

Koch

Borisov

et al. 2018

Front. Behav. Neurosci.

Self Cite

View full text Add to dashboard Cite

Chronic pain (CP) is linked to changes in cognitive function. However, little is known about its influence on number sense, despite the fact that intact numerical-spatial processing is a prerequisite for valid scale-based pain assessments. This study aimed to elucidate whether number sense is changed in CP, to determine if changes have an impact on pain assessments using pain rating scales and what patient factors might contribute. N = 42 CP patients and n = 42 matched controls were analyzed (age range: 33–68 years). Numerical-spatial abilities were investigated by using number line tasks, where participants either estimated the position of a given number (position marking) or the value of a predefined mark (number naming). Pain intensity was assessed using numerical rating (NRS), verbal rating (VRS), and visual analog (VAS) scales. Additional measures included attention and working memory, verbal intelligence, medication and depression. Results revealed that in number naming, patients deviated more from expected (correct) responses than controls, and that VAS scores were significantly higher than both NRS and VRS and correlated with deviations in position making. Changes in number naming were predicted by pain intensity, sex and IQ but not by attention, memory or opioid medication. This article presents new insight on which cognitive mechanisms are influenced by CP with the focus on numerical spatial abilities. It could therefore provide useful knowledge in developing new pain assessment tools specifically for patients suffering from CP.

show abstract

Section: Discussionmentioning

confidence: 99%

The Influence of Chronic Pain and Cognitive Function on Spatial-Numerical Processing

Spindler

Koch

Borisov

et al. 2018

Front. Behav. Neurosci.

Self Cite

View full text Add to dashboard Cite

show abstract

“…This approach maintains the focus on ‘the pain,’ as defined by the subjective rating, and the presumption that reducing the NPR will normalize the associated components including one’s quality-of-life. Despite the lack of correlation between statistically significant changes in the subjective pain rating and improvements in functioning ( McCracken et al, 2002 ; Jensen et al, 2004 ; Shah et al, 2015 ) as well as patient satisfaction with treatment ( Comley and DeMeyer, 2001 ), there appears to be a rigid adherence to changes in NPR scores as the primary indicator of therapeutic efficacy and effectiveness ( Farrar et al, 2001 ; Ballantyne and Sullivan, 2015 ; Sullivan and Ballantyne, 2016 ). Admittedly, the use of multidimensional outcomes is encouraged ( Gewandter et al, 2014 ), but they are frequently considered secondary to a reduction in the pain intensity rating.…”

Section: Introductionmentioning

confidence: 99%

Chronic Pain as a Hypothetical Construct: A Practical and Philosophical Consideration

Doleys¹

2017

Front. Psychol.

View full text Add to dashboard Cite

Pain has been defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Chronic pain is usually described as pain that has persisted for 3–6 months and/or beyond the expected time of healing. The numerical pain rating (NPR) is the customary metric and often considered as a proxy for the subjective experience of chronic pain. This definition of pain (chronic) has been of significant heuristic value. However, the definition and the models it has spawned tend to encourage the interpretation of pain as a measurable entity and implies that the patient’s experience of pain can be fully comprehended by someone other than the person in pain. Several major models of pain have been scrutinized and found to propagate the notion of pain as a ‘thing’ and fall prey to biomedical reductionism and Cartesian (mind-body) dualism. Furthermore, the NPR does not appear to capture the complexity of chronic pain and correlates poorly with other clinically meaningful outcomes. It, and other aspects of the current notion of chronic pain, appear to be an extension of our reliance on the philosophical principles of reductionism and materialism. These and other shortcomings identified in the IASP definition have resulted in an increased interest in a reexamination and possible updating of our view of pain (chronic) and its definition. The present paper describes an alternative view of pain, in particular chronic pain. It argues that chronic pain should be understood as a separate phenomenon from, rather than an extension of, acute pain and interpreted as a hypothetical construct (HC). HCs are contrasted to intervening variables (IV) and the use of HCs in science is illustrated. The acceptance of the principles of nonlinearity and emergence are seen as important characteristics. The practical implications and barriers of this philosophical shift for assessment, treatment, and education are explored. The patient’s narrative is presented as a potential source of important phenomenological data relating to their ‘experience’ of pain. It is further proposed that educational and academic endeavors incorporate a discussion of the process of chronification and the role of complexity theory.

show abstract

“…Depending on the measure, 18%–25%reported a clinically important improvement (using MIC) in pain and quality of life. A study in a single UK tertiary pain centre using the same MIC calculations reported that 16%–23% of patients improved (Shah et al, ), a comparable proportion. Others have reported far greater improvement.…”

Section: Discussionmentioning

confidence: 92%

Implementation of Patient‐Reported Outcomes (PROMs) from specialist pain clinics in England and Wales: Experience from a nationwide study

Price

Williams²,

Smith

et al. 2019

European Journal of Pain

View full text Add to dashboard Cite

Introduction Evaluating outcomes in routine clinical practice is a significant challenge for specialist pain clinics due to the complexity of interventions provided and the subjective nature of pain. This study reports findings from implementation of Patient Reported Outcomes (PROMs) in pain clinics in England and Wales between 2011 and 2013. Methods A paper‐based questionnaire was administered at a first appointment in participating centres. This assessed quality of life, experience of health care and health care usage with postal follow‐up at 6 and 12 months by the research team. Feasibility was assessed in terms of response rates, completion rates and outcomes. Results Ninety‐one (56%) clinics participated, entering 9,588 patients (19% of those eligible). For responders, there was a 92% item completion rate. The dropout rate was high, 46% and 19% returned questions at 6 and 12 months, respectively. Quality of life at baseline was low, with a mean EQ5D‐3L Time Trade Off value of 0.32. Amongst responders at 12 months, 92% continued to experience significant pain. For those with planned discharges 30% achieved the Minimal Important Change for quality of life. Nonetheless, 70% reported positive experiences of care. Conclusions Patients attending UK pain clinics report an extraordinarily poor quality of life and difficulty with understanding their condition. Problems with PROMs implementation included initial recruitment, follow‐up response rates, classification systems and benchmarking. Successful implementation should include use of electronic data capture, feedback and focus on gradual improvement. To achieve this would require extended periods of funding. Significance No nationwide evaluation of the effectiveness of specialist pain clinics had previously been attempted. Comparison of patient outcomes from services enables improvement. This work provides a platform to improve methods of routine PROMs capture in pain clinics, measure clinical effectiveness and identify areas for potential research.

show abstract

Different measures, different outcomes? Survey into the effectiveness of chronic pain clinics in a London tertiary referral center

Cited by 6 publications

References 39 publications

The Influence of Chronic Pain and Cognitive Function on Spatial-Numerical Processing

The Influence of Chronic Pain and Cognitive Function on Spatial-Numerical Processing

Chronic Pain as a Hypothetical Construct: A Practical and Philosophical Consideration

Implementation of Patient‐Reported Outcomes (PROMs) from specialist pain clinics in England and Wales: Experience from a nationwide study

Contact Info

Product

Resources

About