What Really Matters in the Treatment of Chronic Pain

What Really Matters in the Treatment of Chronic Pain: 

Significant Signals Revealed through the CHOIR Registry of Real World Patients

Overview

Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don't know which half is which.
- Charles Sidney Burwell, MD; Dean of Harvard Medical School, 1935-1949

The Learning Health Systems framework [IOM] applies advanced analytics to real-world data. The patterns uncovered through by this approach identify novel interventions and demonstrate the efficacy of interventions amongst a homogenous patient population.  For the more than 25 million Americans living with daily chronic pain [SAMHSA, 2017], these insights can't come soon enough. 

The economic cost of chronic pain to the United States exceeds $635,000,000 per year. That’s more than the impacts of heart disease, stroke, cancer and diabetes combined [IOM, 2014]. Every clinician needs to utilize what truly works when treating chronic pain, and how to leverage data-driven insights to provide the best patient care.

Accreditation & Designation

Release date: This activity was released 3/6/2020.

Peer reviewed: This activity was peer reviewed 2/10/2023

Termination date: The content of this activity remains eligible for CME Credit until 2/9/2026, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this Enduring Material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Learning Objectives

As a result of participating in this activity, learners will be better able to:

• Recognize factors associated with prescription opioid misuse amongst persons with chronic, non-cancer pain
• Interpolate assessments of fatigue for persons with non-cancer, chronic pain with the impact upon sleep, pain intensity, and depression
• Deconstruct the causal interactions between pain intensity, anger, depression, physical function, and social interaction
• Modify prognoses based upon patient-specific lifestyle factors
• Integrate broad-based, real-world outcomes data into the development of treatment plans and algorithms

Desirable Physician Attributes

• Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
• Provide Patient-centered Care [IOM] Identify, respect, and care about patients’ differences, values, preferences and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health
• Systems-based practice [ACGME] Awareness and responsiveness to larger context and system of health care, use of system resources
• Professionalism [ACGME/ABMS] As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
• Utilize informatics [IOM] Communicate, manage knowledge, mitigate error, and support decision making using information technology

References

• Pizzo, P. A., Clark, N. M., & Carter-Pokras, O. (2011). Relieving Pain in America: A blueprint for transforming prevention, care, education, and research. IOM (Institute of Medicine).
• Mackey, S. (2014). National pain strategy task force: the strategic plan for the IOM pain report. Pain Medicine, 15(7), 1070-1071.
• Dzau, V. J., & Pizzo, P. A. (2014). Relieving pain in America: insights from an Institute of Medicine committee. JAMA, 312(15), 1507-1508.
• Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., ... & Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. Morbidity and Mortality Weekly Report, 67(36), 1001.
• Von Korff, M., Scher, A. I., Helmick, C., Carter-Pokras, O., Dodick, D. W., Goulet, J., ... & Terman, G. (2016). United States national pain strategy for population research: concepts, definitions, and pilot data. The Journal of Pain, 17(10), 1068-1080.
• Worley, S. L. (2016). New directions in the treatment of chronic pain: national pain strategy will guide prevention, management, and research. Pharmacy and Therapeutics, 41(2), 107.
• Rogers, W. H., Wittink, H. M., Ashburn, M. A., Cynn, D., & Carr, D. B. (2000). Using the “TOPS,” an outcomes instrument for multidisciplinary outpatient pain treatment. Pain Medicine, 1(1), 55-67.
• IOM (Institute of Medicine). 2008. Evidence-based medicine and the changing nature of health care: 2007 IOM annual meeting summary. Washington, DC: The National Academies Press.
• IOM (Institute of Medicine). 2010. Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches: Workshop Summary. Washington, DC: The National Academies Press.
• Institute of Medicine (US); Grossmann C, Powers B, McGinnis JM, editors. Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary. Washington (DC): National Academies Press (US); 2011.
• Sharifzadeh, Y., Kao, M. C., Sturgeon, J. A., Rico, T. J., Mackey, S., & Darnall, B. D. (2017). Pain catastrophizing moderates relationships between pain intensity and opioid prescription nonlinear sex differences revealed using a learning health system. Anesthesiology: The Journal of the American Society of Anesthesiologists, 127(1), 136-146.
• Sturgeon, J. A., Dixon, E. A., Darnall, B. D., & Mackey, S. C. (2015). Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study. Pain, 156(12), 2627.
• Sturgeon, J. A., Darnall, B. D., Kao, M. C. J., & Mackey, S. C. (2015). Physical and psychological correlates of fatigue and physical function: a Collaborative Health Outcomes Information Registry (CHOIR) study. The Journal of Pain, 16(3), 291-298.
• Karayannis, N. V., Sturgeon, J. A., Chih-Kao, M., Cooley, C., & Mackey, S. C. (2017). Pain interference and physical function demonstrate poor longitudinal association in people living with pain: a PROMIS investigation. Pain, 158(6), 1063.
• Khan, J. S., Hah, J. M., & Mackey, S. C. (2019). Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain, 160(10), 2374-2379.
• Barad, M., Sturgeon, J. A., Fish, S., Dexter, F., Mackey, S., & Flood, P. D. (2019). Response to Botulinum toxin A in a migraine cohort with multiple comorbidities and widespread pain. Regional Anesthesia & Pain Medicine, 44(6), 660-668.
• Hah, J. M., Sturgeon, J. A., Zocca, J., Sharifzadeh, Y., & Mackey, S. C. (2017). Factors associated with prescription opioid misuse in a cross-sectional cohort of patients with chronic non-cancer pain. Journal of Pain Research, 10, 979.

Disclosures of Financial Relationships

Neither the speaker, peer reviewers nor any other person with control of, or responsibility for, the development, management, presentation or evaluation of the CME activity has, or has had within the past 12 months, any relevant financial relationships to disclose. This includes any relationships of an involved person's spouse/partner.