Article
Primary and secondary outcomes regarding chronic non-cancer pain investigated in primary care settings: a systematic literature review
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Authors
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Dominik Henrik Dupont
- Universitätsklinikum Heidelberg, Abt. Allgemeinmedizin und Versorgungsforschung, Heidelberg, Deutschland
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Sabrina Brinkmöller
- Universitätsklinikum Heidelberg, Abt. Allgemeinmedizin und Versorgungsforschung, Heidelberg, Deutschland
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Cornelia Strassner
- Universitätsklinikum Heidelberg, Abt. Allgemeinmedizin und Versorgungsforschung, Heidelberg, Deutschland
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Regina Poß-Doering
- Universitätsklinikum Heidelberg, Abt. Allgemeinmedizin und Versorgungsforschung, Heidelberg, Deutschland
| Published: | September 10, 2024 |
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Outline
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Background: In Germany, about one in 5 patients in General practices report pain that lasts longer than three months or is recurring and thus is chronic by definition. A total of 7.4% of the German population matched the criteria of impeding, non-tumor-related chronic pain in 2014. Guidelines emphasize the importance of treatment being based on the biopsychosocial model and the significance of non-pharmacological measures. The project RELIEF (Resource-oriented case management to implement recommendations for patients with chronic pain and frequent use of analgesics in general practices) aims to develop and evaluate a case-management intervention to improve the management of chronic non-cancer pain of various etiologies in General practice. The intervention development is based on extensive literature reviews and stakeholder surveys.
Objective: To provide an overview of intervention components, primary and secondary outcomes, applied assessment instruments, and effects of programs designed to improve chronic pain management in the primary care setting.
Methods: A systematic literature review was conducted. The PubMed MeSH-term database was used to identify relevant search terms which were then categorized and linked via Boolean operators. Inclusion criteria were: Clinical trials, RCTs (including pilots and protocols) and systematic reviews targeting chronic non-cancer pain in the primary or ambulatory care setting, published between 2013 and 2023.
Results: Search results comprised of 578 publications. After title-, abstract- and fulltext-screening, 60 published trials and 4 systematic reviews were included. The mean number of intervention components was 1.73 (SD: ±1.01), mean number of measured outcomes was 5.93 (SD: ±3,15). Reported primary outcomes were mostly pain- or disability-related, followed by activity, medication-use, quality of life, depression and work-related outcomes. Secondary outcomes were pain-related (53.55%), psychology-related (48.33%) and disability-related (43.33%). Pain-related outcomes were measured frequently with the Brief Pain Inventory and the Numeric Rating Scale whereas psychology-related outcomes were investigated with the Hospital Anxiety and Depression Scale and the Patient Health Questionnaire. Disability- and activation-related outcomes were measured most frequently with the Roland Morris Disability Questionnaire and the Patient Activation Measure. Significant effects were identified for cognitive behavioral therapy based self-management intervention comprising of exercises, education and coping strategies as well as for a patient-centered intervention targeting women with chronic pelvic pain addressing self-care, functional goals and increased productivity.
Implications for research and/or (healthcare)practice: Findings of this literature review are suitable to strengthen the intervention development in RELIEF and contribute to improved care management for affected patients. Literature research focussing on specific etiology of chronic pain should include assessments of degree of comparability and risk of bias.
Funding: BMBF-Strukturförderung Versorgungsforschung/Nachwuchs; Project name: RELIEF; Grant number: 01GY2106
