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.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
High Impact Research and Research Infrastructure Programs (RC2)
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Special Emphasis Panel (ZDA1-SXC-E (5B))
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Aklin, Will
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Weill Medical College of Cornell University
Schools of Medicine
New York
United States
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Bruehl, Stephen; Apkarian, A Vania; Ballantyne, Jane C et al. (2013) Personalized medicine and opioid analgesic prescribing for chronic pain: opportunities and challenges. J Pain 14:103-13
Reid, M Cary; Bennett, David A; Chen, Wen G et al. (2011) Improving the pharmacologic management of pain in older adults: identifying the research gaps and methods to address them. Pain Med 12:1336-57