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The management of chronic pain

 

Contents

NIHR Themed Call: Specification Document

Supporting information:

Severe chronic pain has adverse effects on all aspects of general health as well as on daily life, through its effects on activities, relationships, mood, sleep and employment. Chronic pain is a complex condition that reduces an individual's quality of life, may affect their ability to work and can lead to an increased need for health and social care services.

Chronic pain is usually defined as pain lasting for longer than 3 months. In the UK the average annual incidence has been estimated at 8.3% with an average annual recovery rate of 5.4%, meaning that around 7 to 8 million people may be living with chronic pain in the UK. Many different clinical and non-clinical practitioners may be involved in supporting people with chronic pain, including general practitioners, pharmacists, anaesthetists, psychologists, physiotherapists and nurses. This highlights the wide range of different interventions that may be used in the management of chronic pain, pharmacological, psychological, physical, surgical and other forms of therapy.

A series of national pain audits was undertaken in the UK between 2010-2012 highlighting the wide variation in clinical practice, and access to specialist provision, with the majority of care being provided in non-specialist settings. As chronic pain is itself a major contributor to the burden of ill health and to long term conditions, it is timely that NIHR is initiating a new focus for research into this important issue.

How to apply:

Research proposals must be within the remit of at least one participating NIHR programme. Applications which span the remit of one or more NIHR programme will be welcomed. In these cases proposals should be submitted to the programme within whose remit the major part of the work lies. The inclusion of patient and public views and experiences are considered important by each participating programme.

Applicants who are unsure which programme to apply to may wish to send a short summary (maximum 1 page) of their research proposal to themedcalls@nihr.ac.uk

Applicants from England may wish to contact their local RDS to discuss their application.

All applicants should take note of:

  • the remit of each of the participating programmes (see list below) 
  • the existing NIHR portfolio of published and funded projects in these areas to avoid duplication of research (themed calls)
  • that after the call closes, the participating programmes will continue to be interested in receiving research proposals for the management of chronic pain in areas not otherwise well covered in their portfolios.

Participating Programmes:

The following NIHR managed research programmes:

Efficacy and Mechanism Evaluation (EME)
Health Services and Delivery Research (HS&DR)
Health Technology Assessment (HTA)
Invention for Innovation (i4i)
Programme Grants for Applied Research (PGfAR)
Public Health Research (PHR)
Research for Patient Benefit (RfPB)

The following NIHR research training programmes:

NIHR Research Professorships
NIHR Fellowships
HEE/NIHR Integrated Clinical Academic Programme

For areas of specific interest to the programmes please see below. For further information on the remits and call open and close dates of the participating programmes please see our themed calls.

EME Programme:

Applications to the EME Programme may test interventions for the prevention or treatment of chronic pain. Applications should examine the efficacy of interventions, and may explore the mechanisms underlying possible efficacy.

Applications may investigate novel or repurposed interventions and technologies, but studies of incremental or minor improvements to existing technologies or the discovery of new biomarkers are not within the remit of the EME Programme.

Particular areas of interest include personalised or stratified care, and the use of novel study designs or existing data where their use can help deliver robust findings more quickly or with better value for money.

HS&DR Programme:

The HS&DR Programme funds research to produce evidence on the quality, accessibility and organisation of health and social care services. Robust mixed methods studies are invited with a focus on organisation and delivery of services, costs, quality and patient experience.
Although other topics may be proposed, the following are of particular interest:

  • Primary care-led services for chronic pain including diagnosis, management and self-management and the impact on outcomes compared to secondary care-led services.
  • Comparisons with models of service provision for complex chronic pain provided in community settings including in residential care or on line.

HTA Programme:

The HTA Programme funds research into the clinical and cost effectiveness of interventions. Applications may be for primary research or for evidence synthesis and may use any study design, provided it is efficient and clearly justified. All applications must demonstrate strong patient or public involvement from the outset.

Proposals may encompass research relevant to social care, and the inclusion of occupational and social care outcomes is encouraged. Where relevant, proposals should demonstrate appropriate expertise in social care research.

For primary research multi centre studies that provide statistically robust and generalisable results will be favoured over pilot or feasibility studies.

Areas of particular interest include, but are not limited to:

  • Studies of physical, psychological and behavioural therapies, including patient education 
  • Studies of the effectiveness of complex pain management pathways and interventions
  • Whether earlier referral to more specialist services based in primary or in secondary care can improve outcomes and reduce harms?
  • Studies into the effectiveness of drugs used for chronic pain, e.g. opioids and other drugs that may cause dependency
  • Investigation of strategies for combining drug therapies for optimal efficacy, safety and cost effectiveness

i4i Programme:

The NIHR i4i programme is a translational funding scheme which advances healthcare technologies and interventions for increased patient benefit in areas of existing or emerging clinical need. It supports research and development of medical devices, active implantable devices and in vitro diagnostic devices. Applications fitting the i4i programme remit are encouraged but not limited to the areas of diagnosis, management and self-management of chronic pain in primary and secondary care. Applicants are encouraged to contact the i4i secretariat before submitting an application. The i4i programme will not support basic research activities such as biomarker discovery.

PGfAR Programme:

The PGfAR scheme will support programmes of research which involve a number of interrelated and linked components, using a range of methodological approaches, to answer clinically important questions relevant to the prevention and treatment of chronic pain.

Applications employing novel methodological approaches to demonstrate patient benefit at an individual or population level are encouraged. Examples include development and testing of interventions (including links with industry); using observational data to demonstrate benefit; public health interventions; use of existing data from previous research, or routinely collected health care data. Applications which clearly demonstrate multidisciplinary approaches, and are conducted in geographical locations of high health care need will be welcomed. Research may be carried out in community, primary or secondary care settings.

PHR Programme:

The PHR Programme evaluates non-NHS public health interventions intended to improve the health of the public and reduce inequalities in health. The programme is keen to consider proposals that operate at a population level and which focus on the environmental and social determinants that impact on the prevention and mitigation of chronic pain and its impacts.

PHR is interested in scalable interventions, that act across the life-course, to prevent chronic pain and which enable populations to live well with chronic pain.
PHR is interested in population interventions aimed at reducing the impact of chronic pain and/or the health inequalities characteristic of it. Where justified proposals may focus on populations that are defined by social determinants, rather than by their pain. Health economic evaluations are of interest and we recognise that interventions may be multi-component and that long term follow-up may be necessary to demonstrate effect.

RfPB Programme:

Applications to the RfPB Programme should arise from daily practice in NHS and social care services, and must demonstrate a trajectory to patient, service user, and/or carer benefit. The programme supports applications which are regionally derived and are concerned with studying the provision and use of NHS and social care services, evaluating the effectiveness and cost effectiveness of new innovations and interventions, and developing and refining new interventions, scales or outcome measures. The programme also welcomes applications for feasibility studies, and applications exploring the potential for improving health and wellbeing through needs assessments, methods development, evidence synthesis, systematic reviews, and qualitative, mixed methods and exploratory studies.

NIHR Research Training Programmes:

All NIHR research training programmes are aimed at developing tomorrow’s research leaders and are available at a range of levels depending on the applicant’s background and experience. The new Fellowships programme, Research Professorships and Integrated Clinical Academic Programme will participate in this call, and further NIHR training awards will be potentially involved in the call at a later date.

The opening and closing dates for the participating research programmes is available at out themed calls pages.