RESUMO
BACKGROUND AND AIM: The RADICAL trial has been funded by the National Institute for Health Research (NIHR) to evaluate the clinical and cost-effectiveness of radiofrequency denervation (RFD) for low back pain. Recommendations have been published which aim to standardise selection of patients and RFD technique. However, it is important to ensure these recommendations are acceptable to clinicians within the context of the trial. The aim of this work was to develop standardised criteria for the trial entry and RFD technique for implementation within the RADICAL trial. METHODS: Fourteen pain clinicians completed a survey, which involved reviewing the current recommendations and indicating whether they disagreed with any of the recommendations and if so why. Responses were collated and presented at a half-day workshop with 14 attendees. During the workshop, the National Low Back and Radicular Pain Pathway (NLBRPP) guidelines for patient selection and an article by Eldabe and colleagues presenting recommendations on the RFD technique were reviewed. Attendees discussed whether each component of the recommendations should be mandatory, mandatory with alteration or clarification or optional within the RADICAL trial. RESULTS: Attendees agreed during the workshop that 5 of the 10 criteria for patient selection described in the NLBRPP should be mandatory within the RADICAL trial. Three were agreed as mandatory criteria but required further clarification, one of which involved defining a positive response to a diagnostic medial branch block as ⩾60% pain relief. Two criteria had optional components. After reviewing the recommendations on the RFD technique from Eldabe and colleagues, seven components were agreed as mandatory, three were mandatory with alterations and three were optional. CONCLUSION: When evaluating complex interventions, such as RFD, it is important to ensure agreement and clarity on the clinical protocol, so that the intervention can be reproduced, if found to be effective.
RESUMO
BACKGROUND: The development of chronic pain can result in multiple losses to an individual, which can negatively impact their quality of life. Presentation of the concepts of loss and grief as an interactive educational tool may help those who live with chronic pain gain a deeper understanding of their condition. This in turn may enable more effective management of their pain. This study aims to explore the effectiveness of such a tool through the perceptions and experiences of people living with chronic pain. METHODS: An interactive pain education tool was developed and distributed with an evaluation questionnaire. Participants were invited to re-evaluate the tool three months later. Responses to the questionnaire were provided using a Likert scale and free text comments. Descriptive statistics were used to present quantitative results and inductive thematic analysis was applied to the free text comments. RESULTS: The pain education tool was well received by participants, the majority of whom found the process of using the tool a positive experience. Responses showed the tool helped participants express themselves and promoted self-reflection. The tool provided access to the reflections of others, which helped validate and legitimise their feelings and gain the understanding that their response to pain was normal. This in turn helped promote self-compassion and a sense of belonging, reducing feelings of isolation associated with chronic pain. CONCLUSION: The outcomes of this study show the pain education tool can help individuals gain a new and more positive perspective on themselves and their pain experience, therefore helping them live with and manage their chronic pain.
