Projects and activities
The Integrated Pain Management HIT will focus its combined clinical, research and leadership skills on reducing pain‐associated disability across the lifespan: from children to older adults.
Short term (1-3 years) projects
- Explore GP decision‐making on referral from primary to secondary care services, patient preferences and mapping these against systematic reviews of the literature and adherence to professional / NICE guidance. Improve equity of access
- Secondary care service decision‐making on referral to tertiary care services and patient experience and preferences throughout the pathway of care. This data will be collected via focus groups and one to one interviews. There will be a specific focus on areas of the pathway already known to be suboptimal, for example, transition from paediatric to adult services.
- Map current care against British Pain Society new patient pathways of care to see how current practice meets or falls short of these and systematic review of the literature. Gaps identified in this work would be used to inform our future interventions and will follow a stepped‐design of interventions with concurrent cost analysis.
- Work to 'close the gap' between more medically oriented services and those services that are resourced to provide full biopsychosocial interventions.
- Early adoption of novel HIT‐generated evidence‐based interventions, e.g. telemedicine CBT, management of opioids, devices and technology to relieve pain, dedicated services for older adults, early application of specialist OT/PT and outcome measurement tools.
- Bring together into one unified database repository all of the current local pain‐related databases of patient characteristics and outcome data, with one core data‐set of agreed outcome measures. We will also explore options for unified ethics approval for this database, allowing research and publication on a pain clinical dataset of unprecedented scale.
- Map current training pathways in pain and identify new opportunities for integrated pain‐specific training programmes.
Medium term (3-6 years) projects
- Agree with the CCGs and specialist commissioners a seamless and integrated pathway that delivers chronic pain services from primary to tertiary centres across Bristol and Bath. This pathway will be well understood by all and provide appropriate gateways to ensure optimal patient flow and to minimise inappropriate referrals to the nationally commissioned tertiary service.
- Generate and evaluate novel innovative interventions e.g. sensory discrimination and spinal cord stimulation devices; visual manipulation techniques; motor imagery; novel psychological models and techniques; wider application of CBT interventions to neuropathic pain, pharma and/or pharma combinations.
- Undertake hypothesis‐generating translational studies e.g. application of fMRI (CRiCBristol) to specific chronic pain patient populations and the use of high‐throughput molecular genetics to genotype a large cohort of patients with PDN who do, or do not, respond to the three current analgesic medications in routine use; application of imaging modalities and sensorimotor evaluation with targeted genetics in families where generalised widespread pain crosses generations. These will in turn lead to an improved mechanistic understanding of the human pain substrate and identify novel pain targets for drug discovery/other therapeutic modalities and the submission of external peer‐review grants to fund the generation of novel interventions. Develop and incorporate new psychometric measures of clinical outcome and treatment process in chronic pain treatment.
- Develop and conduct clinical studies and trials into the effectiveness of interventions, including chronic post‐surgical pain, multi‐modal interventions for diabetic neuropathy, and pain rehabilitation optimised services for patients with pain plus autistic spectrum disorder. Other trials are planned such as when best to use SCS and/or rehab in the treatment of CRPS, targeted physical therapy in hypermobility related pain in adolescents/young adults, evaluation of drug therapies currently used in childhood/adolescent CRPS.
- Collaborate in development of new interventions, including those using novel technologies via members of the HIT's involvement in projects such as SPHERE and new multi‐disciplinary funding applications.
- Set up and run comprehensive education and training programmes of undergraduates and postgraduates. Focus on appropriate training of primary health care teams (GPs, nurses, physiotherapists, psychologists, OTs etc) and rotational training posts across the Trusts and three Universities. Systematically research and test the efficacy of psychological skills‐teaching packages for clinicians in chronic pain treatment. Improve and standardise the training of Advanced Pain Trainees hoping to pursue a career as a consultant in Pain Medicine (alongside the Royal College of Anaesthetists). Ensure excellent interface between research activities and education.
Longer term (6-10 years) projects
- Establish the Clinical Pain Consortium as the premier UK integrated evidenced‐based life‐course chronic pain service.
- Maintain clinical and research expertise in the full range of evidence‐based pain interventions, from basic science / drug development to rehabilitation and psychological techniques.
- Establish working mechanisms for the uptake of new evidence into practice, ensuring the rapid adoption and spread of effective practice across the AHSN.
- One regional database of patient characteristics including treatment and outcome data will be in use across the region for all patients with pain.
- Provide a training model for staff rotating between individual centres.
- Implement effective interventions based on evidence from our wide‐ranging programme of research.