Value of Treatment: Transversal Topics

Case study on Chronic Pain disorders (2020-2023)

The Value of Treatment for brain disorders (VOT) is a health economics and outcomes research initiative coordinated by the European Brain Council (EBC). The Value of Treatment (VOT) initiative aims to examine health gains and socio-economic impacts resulting from optimised healthcare interventions in comparison with current care or inadequate treatment and converge data evidence to policy recommendations on how to improve the care pathway(s). Convinced that a complex issue such as chronic pain would benefit from the VOT methodology, a case study on this transversal topic was launched by EBC in December 2020.

The WHO ICD-11 classification was used to select three types of chronic pain disorders.

1. fibromyalgia (as an example of primary chronic pain)
2. painful diabetic neuropathy (as an example of chronic secondary neuropathic pain)
3. non-specific low-back pain (as an example of musculoskeletal pain considered as a common type somewhere in the continuum between chronic secondary and chronic primary pain).

In line with the VOT research methodology, the objectives of the study are:

1. To explore the patient pathway of adults of working age in the three selected diseases: fibromyalgia, painful diabetic neuropathy, non-specific low-back pain.

The study will focus on the following gaps:
a. Long waiting times to access primary care (GPs)
b. Lack of referrals to secondary care between primary care – secondary care & tertiary care (fibromyalgia and non-specific low back pain).

2. To compare best practice healthcare intervention:
Interdisciplinary Multimodal Chronic Pain Management with current care:
monomodal therapy (drug or physiotherapy or psychotherapy alone) in adults of working age

For the definition of ‘Interdisciplinary Multimodal Chronic Pain Management’, the working group refers to the components of interdisciplinary chronic pain management as defined by IASP and the 2017 article published in Pain Journal. In dialogue with the patients, the working group considers that Interdisciplinary Multimodal Chronic Pain Management must combine the following modalities/therapies according to a plan: Medication, Physiotherapy, Psychotherapy/mental health interventions, Complementary medicines, Self-management.

Self-management is used as a broader term that includes self-medication as well as patients actively involved in treatment and care decision-making. It may also include other aspects such as diet or exercise.