Impact case study database

A number of major health insurance providers in the US have developed their reimbursement policies in light of these reviews. Based on the combined recent membership figures for these 4 insurance schemes (53,400,000 members) and a prevalence of persistent pain of 10-20% these policies apply to between 5,300,000 to 10,600,000 people with health insurance. The reviews have enabled important evidence-based policy decisions which allow for more efficient clinical provision and reduce patient exposure to ineffective and unproven treatments.

Between 2017 and 2019, policies from United Healthcare [2.1], Regence [2.2], UCare [2.3] and the Government Employers Health Association (GEHA) [2.4] used the review on the topic [1.1] to justify not routinely offering non-invasive brain stimulation techniques for chronic pain.

A range of information resources have been designed, underpinned by the evidence in these reviews, for people in pain and clinicians to inform their understanding of the condition and their treatment choices.

The PainHEALTH website [2.5] is a Western Australia (WA) Department of Health government funded website developed through a collaboration of researchers, clinicians and consumers, with the specific goal of promoting timely access to reliable and practical pain management resources for all Western Australian health consumers and improving access to good information to people with musculoskeletal pain in remote and hard to reach communities. At the invitation of colleagues in WA, Dr O’Connell led the development of patient facing online information relating to CRPS for the website.

This information on CRPS was directly based on Brunel reviews [1.3, 1.5] and summarises for the lay reader which treatments show promise and which appear to be unsafe and/or ineffective across the full range of treatments including drugs, invasive procedures and non-pharmacological options. The pages went live in 2017. Tracking use statistics show the website is well accessed with over 1,000,000 visitors per year benefitting from trustworthy, accessible and up to date information about their pain, and has a global reach, with users accessing the resource from over 150 countries. The page on managing CRPS received over 5,000 visitors in January 2019 alone suggesting a reach of approximately 60,000 users per year for this rare condition. A formal mixed methods evaluation of the painHEALTH project included 414 users of the resource and found that users perceived it as filling an important gap in holistic pain care, and that it provided holistic and credible information to support self-management and co-care of pain. Health professionals reported that they perceived it to be a useful tool to complement clinical care and training [2.6]. The website has now been approved for a further 5 years of government funding (2018-2023 AUD125,000, equivalent to GBP70,000 (11-2020) and Dr O’Connell will continue to work with the painHEALTH team to further enhance the information on CRPS based upon this research.

Patients and clinicians increasingly turn to internet-based information sources to inform decisions about care and it is important that information based on the best evidence to date is freely available. A range of patient and clinician facing online resources independently developed information resources and recommendations relating to various treatment options for persistent pain that are underpinned by these reviews. Patient-facing resources include the respected and award-winning UK-based “Patient.info” website (formerly patient.co.uk) who cite the Brunel review of TENS for neuropathic pain [1.4] in their patient information resource on TENS [2.7], the US Women’s National Health Network who cite the same review in their information on alternatives to drugs for chronic pain [2.8]. Information resources for clinicians include the “Uptodate.com” [2.9] and “Practical pain management” [2.10] websites who provide clinician updates on best clinical practice for CRPS, and ketamine use with the evidence in reviews 1.2 and 1.5 as critical evidence sources. These resources have considerable global reach. According to information on their websites, Patient.info has over 6,000,000 users; UptoDate is used by approximately 1,700,000 clinicians to stay abreast of current evidence across over 190 countries, and Practical Pain Management has a print circulation of more than 41,000 with over 700,000 unique website visitors per month.

This research has directly helped improve healthcare policy for between 5,300,000 to 10,600,000 people in pain with health insurance in the US. It informs trustworthy, accessible information to clinicians and people with pain about pain management that has global reach.