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American Pain Society
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David A. Williams, PhD, Department Editor
Joan Romano, PhD
The Psychosocial Research Special Interest Group (SIG) met in March 2002 during the APS Annual Scientific Meeting in Baltimore. The meeting, chaired by Bob Kerns, PhD, focused on new directions in outcome assessment, including the development and selection of outcome measures for clinical trials. The meeting featured a presentation by C. Richard Chapman, PhD, “New Directions in Outcome Measurement of Psychosocial Interventions for Pain.” Dr. Chapman says with the advent of evidence-based medicine, there has been rapid change in how interventions are evaluated. This necessitates the demonstration of outcomes relevant to a broader audience of clinicians, payers, and researchers. Outcome measures increasingly provide a basis for making decisions about healthcare expenditures, resulting in concomitant demand for a new degree of methodological rigor in outcome assessment.
Chapman noted the Cochrane Collaboration has been a leader in this movement by setting rigorous standards for evaluating studies included in meta-analyses and systematic reviews. Ideally, each study should be randomized and include attention to issues of validity, sample size, appropriate measures, and appropriate statistical analyses. The Cochrane Collaboration has championed the use of the number needed to treat (NNT) statistic, a measure of the number of patients who must be treated to demonstrate a given outcome. NNT is calculated by dividing 1 by the proportion of patients benefiting from treatment minus the number benefiting from the control treatment. NNT can also be used to compare different endpoints in a study. In addition, one can calculate a similar statistic, the number needed to harm (NNH), which provides a useful index of adverse events. Psychosocial researchers interested in learning more about these standards should go to the Cochrane Collaboration Web site (www.cochrane.org) and download the Cochrane Reviewer’s Handbook.
Dr. Chapman encourages psychosocial researchers to begin incorporating an array of measures more closely tied to key provider and patient outcomes into their research. Such outcomes include number of physician and emergency room visits, hospitalizations, and surgeries; drug costs; and return to work. Key outcomes of interest to employers, compensation boards, and disability insurers may include sick absenteeism, disability, decreased productivity, coworker overload, and litigation.
During the ensuing discussion, it was noted that in many respects, psychosocial treatments have a stronger empirical base of support than interventions in other areas. Some positive trends include support for multicenter trials of pain management in the VA system and increasing attention to measuring outcomes such as disability and function as well as pain reported in medication trials. It was suggested a function of the Psychosocial Research SIG might be to develop a consensus for the incorporation of certain outcome measures into clinical studies of treatment efficacy or effectiveness.
In the business portion of the meeting, a new steering committee for 2002-2003 was voted-in. Committee members are Frank Keefe, PhD (chair); Michael Geisser, PhD; Michael Robinson, PhD; Mark Sullivan, MD PhD; and Ray Tait, PhD (the 2001-2002 steering committee members were Bob Kerns, PhD and Joan Romano, PhD (co-chairs); Frank Keefe, PhD; and Dennis Turk, PhD). The Psychosocial Research SIG meeting to be held at the 2003 APS Annual Scientific Meeting will feature presentations of recent cutting-edge research findings.
