Rev. Soc. Esp. Dolor. 2024; 31(3): 185-214
Gisèle Pickering, Mary O'Keeffe, Kirsty Bannister, Susanne Becker, Sonia Cottom, Felicia J. Cox, Elon Eisenberg, David P. Finn, Patrice Forget, Thomas Graven-Nielsen, Eija Kalso, Magdalena Kocot-Kepska, Hugo Leite-Almeida, José Antonio López-García, Mira Meeus, André Mouraux, Bruno Pereira, Livia Puljak, Michiel F. Reneman, Iben Rohde, Ioannis Sotiropoulos, Nathan Skidmore, Thomas R. Tölle, Snezana Tomasevic Todorovic, Andrea Truini, Kevin E. Vowles, Esther Pogatzki-Zahn, Luis García-Larrea, Brona M. Fullen
RESUMEN
Antecedentes: El dolor es la causa principal de discapacidad y calidad de vida limitada en el mundo. A pesar de la carga creciente que esto supone para los pacientes y los sistemas sanitarios, la investigación sobre el dolor sigue disponiendo de una escasa financiación y un escaso enfoque. El hecho de que los asociados identifiquen y prioricen las áreas que necesitan ser abordadas con urgencia en este campo ayudará a decidir los temas a financiar, a reducir los “residuos de investigación”, a mejorar la eficacia de la investigación y la terapia del dolor y a estimular el uso de la evidencia de la investigación. En el presente estudio, la Federación Europea del Dolor (EFIC) ha desarrollado una Estrategia de Investigación sobre el Dolor para Europa.
Métodos: El estudio ha utilizado múltiples métodos, incluyendo búsquedas de literatura, debates de expertos multidisciplinares, un sondeo y una reunión de consenso final. El sondeo transversal se realizó entre 628 investigadores del dolor, médicos clínicos, educadores y profesionales de la industria europeos para obtener la clasificación y la jerarquía de las prioridades en la investigación sobre el dolor. La reunión de consenso final involucró a un comité de expertos multidisciplinares incluyendo a personas con experiencia acumulada de 23 países. El sondeo muestra los debates guiados en los que se acordaron las máximas prioridades.
Resultados: El análisis del contenido identificó nueve temas de estudio en el sondeo, cinco de los cuales se revelaron como máximas prioridades: (i) entender la fisiopatología del dolor; (ii) entender y tratar las comorbilidades;(iii) evaluar de forma crítica las terapias actuales; (iv) desarrollar nuevos tratamientos; y (v) explorar los impactos biopsicosociales del dolor. Se han priorizado los enfoques físico, psicológico y social en la misma medida que los tratamientos farmacológicos. Las máximas prioridades han sido respaldadas por un comité de expertos multidisciplinares. El comité destacó la importancia de comunicar también claramente los conceptos de predicción, autogestión de la prevención y gestión personalizada del dolor en la estrategia final.
Conclusiones: El contenido del listado final de las máximas prioridades de investigación refleja un enfoque holístico de la gestión del dolor. La importancia otorgada a partes iguales a los aspectos físicos, psicológicos y sociales junto a los tratamientos farmacológicos subraya la relevancia de contar con una estrategia completa de investigación con orientación biopsicosocial. El respaldo dado por el comité de expertos a las cinco máximas prioridades, unido al énfasis al comunicar los conceptos de predicción, prevención, autogestión y gestión personalizada del dolor, proporciona una dirección clara para la futura investigación básica, traslacional y clínica.
Relevancia: EFIC ha desarrollado una Estrategia de Investigación sobre el Dolor para Europa que identifica las áreas de investigación sobre el dolor que merecen mayor atención y apoyo financiero. La aplicación y la amplia difusión de dicha Estrategia son vitales para aumentar la realización de urgentes proyectos sobre el dolor, la financiación de la investigación sobre el dolor y la implementación práctica de los hallazgos de la investigación, con el fin último de reducir la carga personal, social y financiera del dolor.
ABSTRACT
Background: Pain is the leading cause of disability and reduced quality of life worldwide. Despite the increasing burden for patients and healthcare systems, pain research remains underfunded and under focused. Having stakeholders identify and prioritize areas that need urgent attention in the field will help focus funding topics, reduce ‘research waste’, improve the effectiveness of pain research and therapy and promote the uptake of research evidence. In this study, the European Pain Federation (EFIC) developed a Pain Research Strategy for Europe.
Methods: The study used multiple methods, including literature searches, multidisciplinary expert debate, a survey and a final consensus meeting. The crosssectional survey was conducted among 628 European pain researchers, clinicians, educators and industry professionals to obtain the rating and hierarchy of pain research priorities. The final consensus meeting involved a multidisciplinary expert panel including people with lived experience from 23 countries. The survey results guided discussions where top priorities were agreed.
Results: Content analysis identified nine survey themes, of which five emerged as top priorities: (i) understand the pathophysiology of pain; (ii) understand and address comorbidities; (iii) critically assess current therapies; (iv) develop new treatments; and (v) explore the biopsychosocial impacts of pain. Physical, psychological and social approaches were prioritized at the same level as pharmacological treatments. The top priorities were endorsed by a multidisciplinary expert panel. The panel emphasized the importance of also clearly communicating the concepts of prediction, prevention selfmanagement and personalized pain Management in the final strategy.
Conclusions: The content of the final top research priorities' list reflects a holistic approach to pain management. The equal importance given to physical, psychological and social aspects alongside pharmacological treatments highlights the importance of a comprehensive biopsychosocial-orientated research strategy. The expert panel's endorsement of five top priorities, coupled with an emphasis on communicating the concepts of prediction, prevention, self-management and personalized pain management, provides a clear direction for future basic, translational and clinical research.
Significance: EFIC has developed a Pain Research Strategy for Europe that identifies pain research areas deserving the most focus and financial support. Implementation and wide dissemination of this Strategy is vital to increase the conduct of urgent pain projects, pain research funding and the implementation of research findings into practice, to ultimately decrease the personal, societal and financial burden of pain.
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