Persistent pain (often referred to as "chronic pain") is pain that continues for three months or more, and does not respond to usual medical treatment. While other research teams have been documenting the impact of persistent pain on recovery and return to work, and identifying the factors that lead to its onset in the first place, ISCRR researchers from the Evidence Review Hub have been evaluating existing treatment options for persistent pain.
ISCRR researchers have produced a series of evidence reviews in this area, in direct response to requests made by WorkSafe and the Transport Accident Commission (TAC). The objective of this work is to help these compensation bodies maximise the health outcomes of claimants with persistent pain.
The first reviews were produced in 2011, after the Health Services Group (a former joint initiative of WorkSafe and the TAC) requested more information about evidence surrounding the effectiveness of the following clinical treatment options:
- Radiofrequency denervation (passing current through tissue adjacent to the target nerve to interrupt the transmission of pain signals)
- Intrathecal infusions (implanting a pump containing medication under the skin over the stomach)
- Neurostimulation (implanting a device under the skin through surgery, before directing electricity through it onto the nerve associated with pain)
Also in 2011, ISCRR in collaboration with the Health Services Group wanted to investigate whether psychosocial interventions were effective in the treatment of persistent pain. ISCRR researchers set about evaluating evidence suggesting that mental health is associated with persistent pain, and assessing current best practice psychosocial interventions.
In 2012, in response to growing consumer sentiment that firmer mattresses were "better for recovery," the Health Services Group requested a review into the relative impact and effect of beds and mattresses on the clinical course of back pain.
In 2013, as part of a larger clinical evaluation of surgery outcomes, WorkSafe and the TAC requested that ISCRR review evidence concerning spinal fusion.
Recently, WorkSafe and the TAC requested updates to ISCRR's original reviews of radiofrequency denervation, intrathecal infusions and neurostimulation, as well as a review of the relatively new treatment of platelet rich plasma or whole blood injections for treating epicondylitis .
Where to next?
The following paper have been published:
- A snapshot review of psychosocial interventions for persistent pain, which confirms the link between persistent pain and psychosocial factors and identifies several effective psychosocial interventions
- A review of studies assessing whether beds and mattresses can help with persistent back pain, which concludes that none of these studies offer a clear answer
- A review of several studies comparing spinal fusion surgery with other treatments which identifies the risk of fusion surgery at around 10% patients, but finds that there is insufficient evidence to accurately compare this surgery with other treatment options
- An initial review of the evidence surrounding radiofrequency denervation (RFD), and 2015 update confirms there is not enough evidence to be clear about the benefits and harms of RFD in the treatment of persistent pain
- An initial review of the evidence surrounding intrathecal infusions, followed by a 2015 update that finds the effect of this treatment to be unclear
- An initial review of evidence surrounding neurostimulation, followed by a 2015 update that identifies significant evidence gaps in terms of this treatment's effectiveness, and also flags its possible harms
- A review of autologous platelet rich plasma or whole blood injections for epicondylitis that identifies three relevant studies but concludes that none of them can prove the injections to be better than placebo injections at alleviating chronic pain.
Watch this space for updates.