A Pilot RCT of a 60 versus 36 hour Pain Management Programme
Research type
Research Study
Full title
A Pilot Randomised Controlled Trial to investigate physical and psychological outcomes from a 60 hour versus 36 hour Pain Management Programme.
IRAS ID
142626
Contact name
Francis Fatoye
Contact email
Research summary
Chronic pain has a significant impact on society and presents a large financial burden in terms of healthcare usage, treatment interventions, unemployment and benefits costs. Chronic pain patients are currently treated within a Chronic Pain Management Service within Halton and St Helens. The current programmes involve multidisciplinary pain management programmes (PMP) with input from Clinical Psychologists, Physiotherapists, a pharmacist and therapy assistants. The current PMP involves 60 hours of clinical time including assessment, 8 week outpatient pain management programme and 3 month follow-up. There are various Randomised Controlled Trials (RCT) and prospective studies that explore the efficacy of PMPs comparing inpatient, outpatient and waiting list controls; or exploring the efficacy of a PMP itself with no control. However, there seems to be a gap in the literature regarding outcomes comparing different lengths of outpatient PMP.
The British Pain Society (BPS) (2007) recommended a PMP of 100 clinical hours, with 25-30 hours showing some effectiveness, however more intensive programmes were deemed to demonstrate improved outcomes (Williams, 1996; 1999, Guzman et al, 2001). In the primary care setting 100 clinical hours is not necessarily feasible due to cost implications and competing priorities. The current 60 hour programme that is offered represents a reasoned alternative within the finite amount of resources available from the local Clinical Commissioning Group. As the BPS stated that 25-30 hours can show some effectiveness, this study will seek to scope out whether completing less hours than the current programme can still demonstrate strong clinical improvements. The BPS (2007) acknowledged that programme delivery is dependent on available resources.
As well as the lack of literature assessing varying outpatient PMPs, this study has been identified as a way to assess the impact of the current PMP and whether carrying out a shorter programme has an impact on overall outcome. This could have resource implications in terms of further justification for the current programme length or indeed reduce resource cost if a shorter programme was deemed to be effective.
The study population will be chronic pain patients referred into the Chronic Pain Management service (CPMS) and triaged by a Consultant Physiotherapist and Clinical Psychologist for assessment for Pain Management Programme. Referrals will be via the Clinical Assessment and Triage Service (CATS) where the patient will have been assessed and screened for sinister pathology by an Advanced Musculoskeletal Practitioner (AMP). The RCT will therefore use incidental sampling (Hicks, 2009) as the patients will be offered the chance to participate upon assessment in the CPMS. Although this is not deemed to necessarily be the optimal form of sampling (Hicks, 2009), it is the most practicable and appropriate in this situation as it is a finite population of chronic pain patients that are referred into the CPMS.
REC name
North West - Liverpool Central Research Ethics Committee
REC reference
14/NW/0311
Date of REC Opinion
23 Jun 2014
REC opinion
Further Information Favourable Opinion