Summary: A study done by Duke University Medical Center shows that early identification of patients at a greater risk of developing chronic pain is not challenging. This can be achieved with greater accuracy using a couple of questions. This can help provide high-risk patients with personalized and early care, resulting in better outcomes.
The new study published in NEJM Catalyst shows that simple methods make early identification of chronic pain risk possible. This helps provide personalized care to patients, resulting in lower opioid use.
Researchers have seen that not all people are prone to chronic pain. In fact, just a small number of people undergoing surgeries or those who have experienced physical trauma might develop chronic pain.
Studies suggest that about 10% of people are prone to chronic pain. In such people, pain may readily become chronic, triggering a range of other issues like mental health problems, behavioral issues, and more. It means that for lowering the burden of chronic pain, early identification is the key. Researchers at the Duke University Medical Center found that identifying high-risk individuals is not challenging, and it is possible to use some simple tools.
Identifying these patients can help reduce the risk of pain becoming chronic. Further, it may also help reduce the risk of issues like opioid overuse and abuse.
For this, researchers created a simple test with just two questions. Interestingly, these two questions were sufficient to identify the risk of chronic pain in most patients. Unlike previous methods, these questions aim to identify the individuals at risk so that early measures can be taken. This can help prevent chronic pain, and even if it occurs, it might be possible to provide better care to such patients with higher cure rates.
The two questions given to the patients were:
- Have you ever felt your pain is terrible, and it’s never going to get any better? (Y/N)
- Have you ever used an illegal drug or prescription medication for non-medical reasons? (Y/N)
The researchers carried out this survey on 13,500 patients. Out of them, 12% responded yes to both questions. Hence, these individuals were classified as those at greater risk of chronic pain. These results correspond to earlier findings suggesting that about one in ten of the patients are likely to develop chronic pain.
Researchers further divided these patients into three groups: high, medium, and low-risk patients. They then provided them personalized care, including referral to pain specialists, social support, and access to behavioral, physical, and nutrition therapies.
Researchers say that they planned the support system based on the guiding principle that people try to do their best to tackle issues as much as possible. Hence, a support network can make a significant difference.
They found that out of 432 high-risk patients, more than half, or 51%, were able to reduce their morphine dosage within a month. Further, by six months, 239 patients were able to reduce their dependence on opioids.
Researchers say that their study found that early identification of chronic pain risk is the key to providing personalized care that is safe and effective. Further, this study shows that identifying those at risk of chronic pain is not challenging. Thus, it is vital to include a proactive approach to healthcare, providing early and personalized care to high-risk patients.
Frequently asked questions
Who is at risk of developing chronic pain?
Not everyone is prone to chronic pain. Only a small number of people who have surgery or physical trauma go on to develop it, and studies suggest about 10% of people are prone to it. In those people, pain can readily become chronic and bring mental health and behavioral problems with it.
What two questions screen for chronic pain risk?
Duke researchers asked two yes-or-no questions. First: have you ever felt your pain is terrible and never going to get better? Second: have you ever used an illegal drug or a prescription medication for non-medical reasons? Of 13,500 patients surveyed, 12% answered yes to both and were placed in the higher-risk group.
Can chronic pain be prevented?
Early identification is the key. Spotting high-risk patients early lets doctors take early measures that can reduce the chance of pain becoming chronic. Even when chronic pain does develop, patients who were identified early can receive better, more personal care, and it may also lower the risk of opioid overuse and abuse.
How does early identification cut opioid use?
High-risk patients received personalized care: referral to pain specialists, social support, and access to behavioral, physical and nutrition therapies. Of 432 high-risk patients, 51% reduced their morphine dose within a month. By six months, 239 patients had reduced their dependence on opioids.
Source:
Gulur, P., Christie, N., Pope, A., Zambrano, D., Vorenkamp, K., & Nelli, A. (2024). Duke Health Integrated Pain and Wellness Program—A Proactive Population Health Model. NEJM Catalyst, 5(4), CAT.23.0308. https://doi.org/10.1056/CAT.23.0308