Research vision: Spine Related Pain
Prof Dr. M van Kleef, Anesthesiologist/Pain Specialist
In spine related pain it is defined that the aetiology of the pain is originated from osseous structures and/or facet joints of the spine and/or from spine related soft tissues and connective tissue structures.
Within the group patients with chronic pain, the spine related pain forms the largest population. In particular pain originating from the cervical/lumbar spine or pelvic ring (sacroiliac joints) forms, with respect to localisation of the pain, the two important subgroups. In first instance, both clinical and experimetal pain research will focus on the diagnostic, therapeutic aspects of pain of the cervical/lumbar spine and pelvic ring (sacroiliac joints).
Within spine related pain, one of the most important problems is the lack of reproducible an validated clinical diagnostic procedures. They are nessecary for making a proper indication for any pain treatment in a patient. In daily practice, the lack of these reproducible and validated somatic diagnostic procedures probably explains the unpredictable outcome of all kinds of pain treatments in the individual patient. The same is true for the contradictory results of RCT's evaluating interventional, non-invasive and coginitive behavioural treatments in patients with spine related pain. Non-reproducible and non-validated somatic diagnostic procedures will lead to heterogeneous study populations used in RCT's. As a consequence, both positive and negative outcomes of efficacy studies can be the result of unknown subgroups in the heterogeneous study population of a RCT.
Based on reproducible diagnostic procedures, study populations for efficacy studies (RCT) can be better defined and will become more homogeneous. Beside the reproducibility aspect, research of somatic and psychocognitive predictors is very important with respect to the outcome and effect size of the different therapeutic treatment modalities and strategies.
A second problem within the topic of spene related pain is the variability of the used interventional pain treatment techniques. This and other factors can explain the difference in treatment outcome of interventional pain treatments in apperently identical patient groups. Research of standardisation of interventional pain treatment techniques and the development of new innovative treatment techniques are of outmost importance.