Musculoskeletal Pain Disorders Clinical Study Group
The musculoskeletal pain disorders CSG is chaired by Professor
Elaine Hay.
Annual report 2009
For more information on the recent activities of the
Musculoskeletal Pain CSG please read the latest annual
report.
Steering group
Members will sit on the group for 3-5 years. The current members
of the CSG are:
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Professor Elaine Hay (Chair)
Professor of Community Rheumatology, Keele University and
Honorary Consultant Rheumatologist, Staffordshire Rheumatology
Centre, Stoke-on-Trent and Clinical Director of the Local (West
Midlands - North) Research Network
Email: e.m.hay@cphc.keele.ac.uk Tel:
01782 583890
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Professor Jim Woodburn
Professor of Rehabilitation Studies, Glasgow Caledonian
University
Email: jim.woodburn@gcal.ac.uk
Tel: 0141 3318483
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Dr Tamar Pincus
Reader in Psychology, Royal Holloway, University of London
Email: t.pincus@rhul.ac.uk Tel:
01784 443523
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Professor Anthony Jones
Professor of Neuro-Rheumatology, School of Medicine, University
of Manchester
Email: anthony.jones@manchester.ac.uk
Tel: 0161 206 4266
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Professor Nadine Foster
Professor of Musculoskeletal Health in Primary
Care, University of Keele
Email: n.foster@keele.ac.uk Tel:
01782 584705
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Professor Gary Macfarlane
Professor of Epidemiology, Department of Public Health,
University of Aberdeen
Email: g.j.macfarlane@abdn.ac.uk
Tel: 01224 552495
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Professor Candy McCabe
Professor of Nursing and Pain Sciences, NIHR Career Development
Fellow, Faculty of Health and Life Sciences, University of the West
of England
and
Consultant Nurse, Bath Centre for Pain Services, Royal National
Hospital for Rheumatic Diseases, Upper Borough Walls, Bath
Email: candy.mccabe@rnhrd.nhs.uk
Tel: 01225 465941 ext. 210
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Dr David Walsh
Director, Arthritis Research UK Pain Centre, Associate Professor
(Clinical Reader) in Rheumatology, Academic Rheumatology,
University of Nottingham Clinical Sciences Building, City Hospital,
Nottingham, NG1 1PB.
E-mail: David.Walsh@nottingham.ac.uk
Tel: 0115 8231751 or 0115 8231766
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Group meetings
The CSG will hold approximately two meetings per year. The CSG
will fund travel costs (second class rail or equivalent) for CSG
meetings (members or their deputies).
Regular teleconferences will also be held. Please click below
for the minutes of these teleconferences:
Members of the CSG will ensure participation in regular CSG
Email Discussion Forums set up to facilitate progress of the CSG’s
research agenda, development of specific projects, and fulfilling
the CSG’s remit.
Other meetings
Musculoskeletal Pain CSG workshops
A meeting was held on 10th October 2008 to discuss the
progress of the Musculoskeletal Pain CSG to date. Read the report from the meeting.
A further workshop was held on 26th October 2009 to provide an
opportunity for networking and a summary of the current status of
the Musculoskeletal Pain CSG. Read the report from the
workshop.
Podiatry research consensus meeting
The CSG recently held a meeting to develop, through consensus, a
prioritised list of research related to musculoskeletal foot and
ankle pain and podiatry. Please click here to view the report from
this meeting. View
the presentation summarising the meeting.
Think tank meetings
Following the Musculoskeletal Pain CSG meeting in October 2008,
the agreed action point from the meeting was to set up further
“Think-Tank” meetings to provide a forum for translating priority
areas into specific research proposals. Further information on this
proposal.
The group have held several ‘Think-tank’ meetings since the CSG
was established. Further information on these meetings is available
below:
Meeting Dates
Strategy
Read the strategy.
The Musculoskeletal Pain CSG, formed by Arthritis Research UK,
will support and develop a comprehensive portfolio of clinical
studies directed towards and including clinical trials in all areas
of musculoskeletal pain across the UK. It will
advise Arthritis Research UK in defining research
priorities in musculoskeletal pain for their support and
adoption.
The CSG will bring together the expertise and enthusiasm
necessary to establish an authoritative voice in the
musculoskeletal pain research community directed towards clinical
trials and related studies.
The CSG will have two main responsibilities:
- Reactive and Proactive - to support and develop a portfolio of
clinical studies directed towards and including clinical trials in
all areas of musculoskeletal pain across the UK
- Advisory - to advise Arthritis Research UK in defining
research priorities in musculoskeletal pain for their support,
submission for external funding and subsequent adoption to run
through the CLRN
The remit of the CSG and its members is to:
- Be responsible for developing and overseeing a comprehensive
portfolio/strategy for clinical trials and related studies covering
the spectrum of major disease areas in musculoskeletal pain
- Propose and support the development of protocols for trials and
related studies. These protocols where relevant will include the
design of pilot and feasibility studies to provide proof of concept
for definitive studies in terms of recruitment, data collection
etc. The CSG will proactively advertise submissions of protocols
needed to satisfy these goals, to be done in collaboration with the
CSG
- Review trial and related study protocols proposed by others
(including industry proposals), to advise the CLRN
and Arthritis Research UK how they may fit into the CSG
portfolio/strategy and how the protocol could be assisted in its
development
- Provide robust scientific evaluation, expert advice and support
to investigators
- Ensure consumer involvement in all activities
- Work in close collaboration with other CLRN and Arthritis
Research UK CSGs
- Consider research “add-ons” to established protocols (e.g.
pharmacogenetics and qualitative studies)
- Provide regular reports to the CLRN and Arthritis Research
UK of its work and recommendations
- Support the development of partnerships with other research
funders (e.g. NIHR, MRC, Welcome, other AMRC funders) and industry
in developing a comprehensive research programme in musculoskeletal
pain
- Uphold the highest standards of Research Governance and Good
Clinical Practice (GCP) throughout its portfolio according to
ICH-GCP guidelines, EU Directives on Clinical Trials and GCP, and
UK law
- CSG members with specific or general expertise may be asked to
evaluate proposed trials from the pharmaceutical industry via the
commercial trials adoption process under development with UKCRN.
Evaluation will include relevance to the NHS and the important
unmet needs of child health, statistical validity (at the level of
an experienced clinical trialist) and feasibility. These
evaluations will need to be undertaken as a matter of priority
Developing the Pain CSG Portfolio
The research priorities for the Pain Disorders Group will be
developed through the following process. This process will be
iterative in response to input from members of the
group, Arthritis Research UK and other group
leaders.
Stage 1: Establish the Musculoskeletal Pain Disorders Clinical
Studies Group
- The Musculoskeletal Pain Clinical Studies Group, consisting of
active research leaders from the field of musculoskeletal pain,
will be established by the Chairman (EH), and terms of reference
agreed
- Nominated individuals will be chosen according to agreed
criteria. This will be a “working” group, chosen from experts in
main topical areas (e.g. back pain, regional pain, widespread
pain); ideally with a range of methodological expertise (e.g.
trials, qualitative, health economics, statistics) and representing
a range of health care professionals, primary and secondary care
and linking closely with representatives from the UK Clinical
Research Network. Patient and public involvement will also be
crucial.
- To ensure that the Group is small enough to function
effectively, ad-hoc working parties will be formed to facilitate
wider consultation and coverage, or to address specific priority
areas (these could be clinical, methodological or professional for
example).
Stage 2: Scoping exercise
The Group will carry out a scoping exercise to
- identify current high quality trial and other clinical research
activity in musculoskeletal pain,
- a mechanism for identifying duplications / opportunities for
collaboration and gaps, and
- an inclusive, multi-professional group of users, researchers
and clinicians to shape, and contribute to, the research programme
and to develop new research questions.
This will be achieved by identifying key stake-holders through,
for example, Special Interest Groups, professional societies (e.g.
Physiotherapy, Pain Society), local and national networks, patient
groups (e.g. Arthritis Care), Arthritis Research
UK's list of grant-holders in appropriate areas, Medline
search to identify Principal Investigators on key publications, and
the National Research Register.
Stage 3: Priority setting
Building on the strengths, weaknesses and opportunities which
will be highlighted by the scoping exercise, the Group, in close
collaboration with the NIHR and other key stakeholders such as
industry, will draw up short and longer (5 year) priorities for the
Musculoskeletal Pain Research Agenda. This will be fed back to the
broader research community for consultation. Once priority areas
are agreed, the Group will widely advertise their proposed
activities and seek submissions of research proposals in the
priority areas. In close collaboration with Arthritis Research UK,
NIHR, and group leaders from other topic specific areas, research
proposals will be assessed to establish their fit with the Pain
Disorders and NIHR priority areas. The ultimate goal will be to
develop a linked series of clinical trials to investigate the
effectiveness of the management of common painful musculoskeletal
problems including conditions such as back pain, regional pain and
widespread pain. The need for robust pilot studies, including
carefully designed clinical cohort studies, proof of concept
studies, feasibility studies of novel interventions, to support the
development of future trials, will also be addressed.
Stage 4: Selecting proposals for development into full
submissions
The exact procedure is being developed by Arthritis Research UK.
It is likely that this will be a two stage process:
- Internal review of outline proposals by the Clinical Studies
Group to identify the most strategically important projects, to
rationalise duplicate projects and encourage collaboration.
- Outline proposals of high quality which “fit” the strategy
would be worked up in a collaborative, facilitative process by the
CSG and PIs to “MRC standard” and internationally reviewed before
being forwarded to a newly formed Arthritis Research
UK committee to agree funding for the research component. A
process will be developed whereby the CSG Chairs work closely with
the Comprehensive Local Research Network Clinical Directors and the
UK Comprehensive Research Network Clinical Trials Unit to ensure
that appropriate infrastructure support and service support costs
are forthcoming from the NIHR.
For the “Pain disorders” group, this process raises particular
challenges. Pain is a symptom not a disease and as such, research
in this area may cut across other groups (e.g. osteoarthritis).
Close collaboration between the Pain group leader and other group
leaders will be crucial. The broad remit of this group does,
however, provide exciting opportunities for multi-professional
research employing a range of methodologies, and for research of
non-pharmacological approaches to pain management. It will be
important that the research portfolio is seen to be inclusive,
covering a broad spectrum of areas including:
- Investigating the efficacy of novel interventions for
musculoskeletal pain.
- Investigating broad models of care for common musculoskeletal
problems including bio-psychosocial approaches, multidisciplinary
working and complementary medicine, which are aimed at preventing
chronicity, rather than providing symptomatic relief only.
- Investigating new models of delivering care for common
musculoskeletal problems, for example using a range of health
professionals working in extended roles, referral to interface
clinics, and IT / Web based innovations.
- Investigating how clinicians’ behaviour can be changed, to
ensure that existing research knowledge is effectively incorporated
into everyday clinical practice.
- Investigating how views of patients and other members of the
public can be truly represented and can constructively contribute
to the research process.
The development of the portfolio will need to be underpinned by
robust and novel methodological approaches, and funding proposals
for pilot work, for example:
- Development and testing of new outcomes for use in research and
clinical practice, including individualised patient-centred outcome
measures.
- Development and testing of robust ways of collecting data in
routine clinical care to facilitate a systematic approach to
recruiting patients into clinical trials in primary and secondary
care across a range of disciplines.
- Broadening of the current methodological framework to include
multiple research approaches (e.g. health economics, health service
research). In particular, qualitative methods will be used both as
part of the development of intervention studies and in parallel to
them to further understand patient and professional views of the
conditions being studied, the treatment and health care being
delivered, and the research process itself.
- Developing novel approaches to investigate mechanisms as well
as outcomes.
- Involvement of practising health care professionals and
patients in formulating research questions and designing
appropriate, credible interventions.
- Working with clinicians to test the feasibility of
incorporating interventions (shown to be effective in the trials
programme), into clinical practice.
Stage 5: Measuring output
One further key task for the Group, together with Arthritis
Research UK, will be to agree success criteria and performance
targets for the research undertaken under the auspices of the Pain
Disorders Group, and to put procedures in place to monitor that
these are being achieved. It is crucial that the whole process
described above is transparent and rigorous, that the targets set
are achievable whilst at the same time ensuring research outputs of
the highest quality, and that the outputs from the research
portfolio can be shown to improve clinical practice and patient
outcomes.
Advisory members
A number of members can be appointed in an advisory capacity on
a regular or an ad hoc basis depending on the needs of the CSG and
related topic-specific subgroups.
Consumer representation
The CSG will involve consumers in all aspects of its work.
Process for this to be discussed.
Priority setting process
Last year we held a 2 day “Think-Tank” at Keele which included a
nationally representative multidisciplinary group of about 30
people who reflected on the findings from recent primary care
trials of treatments for musculoskeletal pain and discussed
recommendations and priorities for future trials.
The “think-tank” discussed methodological issues regarding
recent trials including:
- The heterogeneity of patients within physiotherapy trials may
make it difficult to capture true treatment effects (McCarthy and
Cairns 2005)
- Inadequate identification of important patient subgroups (Hay
et al 2005, McCarthy and Cairns 2005) may lead to insufficient
targeting or individualisation of treatments
- There may be overestimation of the specific effects of
interventions on individual patients and underestimation of the
contribution of the non-specific effects of the interventions
(Thomas et al 2004)
- Despite many trials now using a core set of recommended outcome
measures (eg. Deyo et al 1998), we still fail to capture what is
really important to patients In order to try to address some of
these possible explanations, following a number of small group
workshops, the group came up with 22 recommendations for future
research priorities. These priorities have been ranked by
physiotherapists at the World Congress (2007).
Contact details
For all enquiries and additional information, please contact:
Professor
Elaine Hay, chair of the musculoskeletal pain disorders CSG or
the administrator Ms Claire
Ashmore.