Comparative Effectiveness of Interventions for Chronic Pain Management

描述(由申请人提供)：慢性疼痛是一个主要的公共卫生问题，随着我们知识基础中的差距继续存在和处于危险中的人口的增加，这种问题只会变得更加严重。我们相信我们有一个经济高效的解决方案，可以成为其他疼痛管理机构使用的典范。AIM 1将为纽约市4家采用跨学科疼痛管理治疗的学术医院疼痛诊所的患者建立一个可追溯的慢性疼痛数据登记系统。该登记处将使用来自我们医院使用的电子病历系统的数据库，将包括患者的人口统计特征、发病前状态、受伤和/或疾病相关情况(并发症和合并症)、药物和非药物的治疗干预措施、结果，包括疼痛强度、功能改善、主观幸福感以及与治疗相关的不良反应(包括与药物有关的异常行为)的测量。目标2将使用基于实践的证据(PBE)方法来创建一个全面的、前瞻性的慢性疼痛数据注册中心，以追溯注册中心为基础。这一登记将包括详细的患者特征(包括疾病的严重程度)以及已在四家疼痛诊所标准化的评估、治疗、干预和结果数据。AIM 3将使用这两个登记来确定对特定类型的慢性疼痛患者最有效的特定疼痛管理干预措施。比较有效性将根据上面详述的疼痛管理的主要结果来判断。这些方法将提供机会，严格检查明确界定的癌症和非癌症慢性疼痛患者群体，以确定他们接受的治疗和干预，并使用已成功与其他治疗方法一起使用的多元分析方法比较他们的长期结果。拟议的研究将利用这四家疼痛诊所最先进的治疗专业知识。只有有了这种相对有效的信息，我们才能确定哪些患者将从目前用于治疗慢性疼痛的可用干预措施中获得最大好处。这项RC2申请提供的培训和基础设施将建立一个研究设施，在这项申请的两年支持期之后，可以由私人和公共资金维持。公共卫生相关性：慢性疼痛是一个主要的公共卫生问题，我们的知识基础存在很大差距。我们建议进行一项比较有效性研究，以确定哪些患者将从目前用于管理慢性疼痛患者的干预措施中获得最大好处。这种方法为一个被忽视的研究领域提供了一个具有成本效益的解决方案。

DESCRIPTION (provided by applicant): Chronic pain is a major public health problem that is only growing worse as the gaps in our knowledge base continue and the population at risk grows. We believe we have a cost effective solution that could become a model for other pain management facilities to employ. Aim 1 will establish a retrospective chronic pain data registry for patients of 4 New York City academic hospital-based Pain Clinics that employ interdisciplinary pain management treatments. The registry will utilize a data base derived from the electronic medical record systems utilized by our hospitals and will include patient demographic characteristics, pre-morbid status, injury and/or disease- related conditions (complications and comorbidities), the therapeutic interventions both drug and nondrug, and the outcomes including measures of pain intensity, functional improvements, subjective well-being, as well as treatment related adverse effects (including aberrant drug-related behaviors). Aim 2 will use Practice Based Evidence (PBE) methodology to create a comprehensive, prospective chronic pain data registry, using the retrospective registry as a foundation. This registry will include detailed patient characteristics (including severity of illness) and assessments, treatments, interventions, and outcomes data that have been standardized across the four Pain Clinics. Aim 3 will use both registries to identify specific pain management interventions that are most effective for specific patient types with chronic pain. Comparative effectiveness will be judged by primary outcomes of pain management detailed above. These approaches will provide the opportunity to rigorously examine well defined cancer and noncancer populations of chronic pain patients to determine the treatments and interventions they receive and to compare their long term outcomes using multivariate analytical approaches that have been successfully used with other treatments. The proposed studies will leverage state of the art treatment expertise in these four pain clinics. Only with this comparative effectiveness information can we determine which patients will derive maximum benefit from the currently available interventions used for the management of chronic pain. The training and infrastructure provided by this RC2 application will establish a research facility that can be sustained by private and public funding beyond the two year support period of this application. PUBLIC HEALTH RELEVANCE: Chronic pain is a major public health problem and large gaps exist in our knowledge base. We propose a comparative effectiveness study to determine which patients will derive maximum benefit from the currently available interventions used for the management of chronic pain patients. This approach provides a cost effective solution to a neglected area of research.