The Department of Health has already spent over £18 million on self-management courses for up to 100,000 patients, but the evidence that these programmes actually work remains patchy. This research aims to fix that gap for people living with chronic non-malignant pain—a condition affecting between 46% and 73% of the population, with its worst impact hitting people in their economically active middle years. The problem is straightforward: despite a better scientific understanding of what causes chronic pain, how to manage it successfully has barely improved. Self-management programmes encourage patients to take an active role in their own care, and the NHS has made this a priority. But while these courses may boost patients’ confidence, their effect on clinical outcomes is uncertain, and their social and economic benefits remain largely unexplored. If this research succeeds, it will produce a rigorously tested, cost-effective self-management programme tailored specifically for chronic pain. The team will identify which patients are most likely to benefit, develop a refined intervention, and run a full randomised controlled trial to measure both clinical effectiveness and cost-effectiveness. The end goal is a programme that the NHS can roll out nationally, backed by training materials for providers and clear guidelines for clinicians—turning a £18 million investment into something that actually improves lives.
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Aims/Objectives Our overall aim is to develop a method to improve the quality of life, clinical and social outcomes, and reduce the health care resource use, of people living with chronic, non-malignant pain, specifically via a self management programme derived from a modified, condition specific, version of the Expert Patients Programme (EPP) (1).The objectives are to develop a new self management programme and to evaluate its effectiveness and cost effectiveness. BackgroundChronic pain has a huge impact on health and society (2); the prevalence of chronic pain is between 46% and 73% (2-5).The health impact of chronic pain peaks in the economically active middle years of life (6). Despite increased understanding of the factors contributing to the development of chronic pain, there has been little improvement in how successfully it is managed (4). The self management approach encourages patients to take an active part in the management of their own conditions. Self-management groups may have a role in supporting patients. Improved self management for long term conditions is an NHS priority (7). The Department of Health (DH) has invested in excess £18m in the delivery of self management programmes with the aim of providing courses for up to 100,000 patients (8,9), but the evidence for their effectiveness varies (10). Whilst clinical outcomes may not alter, measures of self efficacy (confidence) show more promise (10). Individual and social outcomes are relatively unexplored. This programme of research seeks to maximize and quantify the potential health and social benefits of a self-management approach for chronic pain.Research Plan Phase 1 (Months 0 -12)1. Identify the key components of potentially effective self-management strategies by systematic review of the scientific literature. 2. Identify predictors of response to treatment in chronic painful disorders, by systematic review, to inform selection criteria for subsequent trials and choice of intermediate outcome measures that will indicate those most likely to be responsive to self management interventions.3. Explore participants’ and tutors' experiences of self management programmes for chronic painful conditions in order to identify effective practices, using qualitative methods. Phase 2 (Months 12-18)4. Develop a preferred list of patient centred outcome measures for evaluating self management programmes informed by phase 1.5. Develop an enhanced intervention to improve the self management of chronic painful conditions.Phase 3 (Months 18- 57)6. Inform refinements to the intervention design, and assess the potential of rolling the programme out nationally, by modelling the intervention's likely effects both conceptually and statistically.7. Conduct a feasibility study for the enhanced self management programme and a pilot randomised controlled trial (RCT) to test procedures for the main RCT.8. Assess the effectiveness, and cost-effectiveness, of the new, optimised self management intervention in a population selected to be most likely to benefit (selection based on Projects 2 and 3) via a RCT.Phase 4 (Months 54–60)9. Identify factors that would facilitate easy implementation of the new initiative; develop training material for self management delivery organisations and guidelines for clinicians. Research TeamTwo experienced researchers will act as joint principle investigators: ST (expertise in the efficacy of self management of chronic conditions), in London; and MU (expertise in chronic painful disorders and clinical trial design and implementation), in Warwick. We bring together extensive expertise and experience in self management programmes; musculoskeletal pain; visceral pain; pain clinic medicine; the design and evaluation of complex interventions including the EPP; health psychology; health services organisation/ NHS management; statistics; health economics; qualitative research; research synthesis; outcome measures and trial management. Research EnvironmentThi
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