Revolutionary New Tool Helps Identify Future Chronic Pain Patients
Chronic pain is one of the most pervasive and costly public health issues in the United States. Chronic pain conditions like low back pain, arthritis and migraines afflicts more than 30 percent of the U.S. adult population, costing more than $560 billion annually in medical expenses and lost productivity. Chronic pain costs the U.S. more than that of cancer, diabetes and heart disease combined.
Despite advances in pain medicine, many chronic pain patients with moderate to severe pain symptoms still experience disruption of daily activities. According to the Centers for Disease Control and Prevention, almost 8 percent or 20 million U.S. adults experience high-impact chronic pain that interferes with daily life.
Unfortunately, once chronic pain appears, it may last months, years or the rest of the patient’s life even with medical intervention. That is why there is renewed emphasis on preventing this condition before it arises. One of the keys to this preventive care is identifying high-risk individuals using an evaluation tool that recognizes biological, psychological and social markers of elevated risk.
This biopsychosocial model is the basis for a new screening tool called the FUTUREPAIN questionnaire. The FUTUREPAIN questionnaire is able to predict which patients will develop moderate to severe pain in 7 to 10 years with an accuracy of greater than 80 percent. Unlike other questionnaires that are designed for use with patients already experiencing pain symptoms, the FUTUREPAIN questionnaire is intended for any patient.
What Is the FUTUREPAIN Questionnaire?
Designed by Timothy Brown and Woojung Lee, the FUTUREPAIN study leveraged existing survey knowledge about chronic pain patients to develop a questionnaire consisting of 17 risk factor elements. These elements include clinical history, traumatic childhood events and personality traits. In addition to identifying individuals who are at elevated risk of developing chronic pain, additional FUTUREPAIN studies will help develop strategies for minimizing the risk of future chronic pain.
Although there are only 17 topics in the screening tool, the FUTUREPAIN questionnaire actually is based on a biopsychosocial model that has 82 possible variables. Among the possible 11 clinical variables, the FUTUREPAIN questionnaire addresses the following 6:
- Body mass index
- Sleep quality
- Number of head injuries
- Number of car accidents involving and injury
- Number of joint injuries
- Number of surgeries
Of the potential 39 social variables that could have been included, only 5 made it into the questionnaire:
- Employment status
- Parental abuse
- Death in the family within the past 5 years
- Loss of home due to fire or flood
- Loss of financial security due to changes in work status
Among psychological variables, only four out of 20 were included:
- Kessler K6—this measures non-specific psychological distress
- Anxious arousal
- Loss of interest
- Religiousness and spiritual daily guidance
How the FUTUREPAIN Questionnaire Was Designed
The FUTUREPAIN questionnaire is based on the National Survey of Midlife Development in the United States or MIDUS. MIDUS collected medical and personal data on a national population of 945 siblings including twins. Originally collected in 1995-1996, MIDUS also included two follow-ups in 2004-2006 and 2013-2014.
Using two-thirds of the MIDUS results, the FUTUREPAIN team used a predictive machine learning model to develop its questionnaire. This model employed a least absolute shrinkage and selection operator (LASSO) algorithm that minimized the number of covariates and enhanced its predictive accuracy.
The FUTUREPAIN model was then applied to the one-third of MIDUS survey results previously unutilized to evaluate its accuracy. The FUTUREPAIN model accurately predicted whether a patient developed chronic pain in 85 percent of the cases applied.
How FUTUREPAIN Can Ameliorate the Chronic Pain Crisis
Almost one third of all American adults are experiencing one kind of chronic pain at any given time. Although there are a burgeoning number of pain management therapies, the reality is that most chronic pain patients will never recover. This leaves millions of Americans with truncated or disrupted lives that are restricted by pain episodes.
The most powerful methods of pain management include drugs, cognitive retraining, and lifestyle changes. Medications like opioids have serious health consequences that include impaired breathing, chemical dependency, or death. Due to the epidemic of opioid addiction, more physicians are limiting the use of these medications to extreme cases and for only limited periods.
Other kinds of pain management like behavioral modification, physical therapy and lifestyle adjustment involve an investment of time and effort that may be more than many patients can afford. There is often a long period in which the patient learns new pain management techniques with little or no improvement that can prove frustrating and cause termination.
These kinds of challenges are why more medical experts are turning to preventive measures as an alternative to treatment. In most cases, physicians currently employ screening systems for patients already exhibiting pain symptoms. Tests like the Örebro Musculoskeletal Pain Questionnaire help identify potentially disabled persons after suffering a musculoskeletal injury. Similarly, the Acute Low Back Pain Screening Questionnaire and the Vermont Disability Prediction Questionnaire measure risk of developing chronic low back pain following a health incident.
Although these tools have some efficacy in identifying patients with an elevated risk of developing chronic pain if already experiencing pain, they are designed for use with a general population not already receiving medical care.
The FUTUREPAIN tool can help mark 4 out 5 people who are likely to develop chronic pain. This is truly an amazing predictive model that could help clinicians highlight high-risk patients and act early to limit that risk.
The FUTUREPAIN system is not yet fully realized because additional research is needed to pinpoint the appropriate strategies to mitigate the risk of developing chronic pain. The team behind FUTUREPAIN is already working on this aspect of their system, but real clinical efficacy in preventing chronic pain is dependent upon how well these techniques are. For example, they will need to design a program that sidesteps natural patient reluctance to prevent a harm that has not yet occurred. Furthermore, they may need to design incentives to keep higher risk patients participating in the prevention program for years.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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