The overall goal of the PAIN OUT project is to improve clinical decision making in the treatment of patients with post-operative pain. This should result in optimizing the treatment outcomes of European citizens following surgery. To this end, postoperative pain management may serve as an example for other fields of medicine. The project's main objective is to develop and validate a system for the continuous measurement, feedback and benchmarking of treatment quality in the field of postoperative pain.
This system will allow comparison of quality of postoperative care between different countries and health care settings and provide clinicians with treatment recommendations based on measured patients' outcome. Further main objective is the development of a Clinical Decision Support System (CDSS) and an Electronic Knowledge Library (EKL) for post-Operative Pain. The CDSS will respond to queries made by physicians for real-time advice regarding treatment of individual patients. The EKL provides clinicians with easily accessible and regularly updated summaries of evidence-based recommendations tailored to specific post-operative situations.
Every year, surgery is performed on over 40 million patients in the European Union. At least half of these patients suffer from moderate to severe post-operative pain. The price of poorly managed postoperative pain is very high. Pain impedes recovery; it causes suffering and overloads health care resources. Resolving pain is a moral obligation of every healthcare provider. The field of postoperative pain is characterized by a large variability in clinical care and treatment results, similar to some other fields of medicine.
As it is often the case in medicine, guidelines and quality assurance initiatives have changed management of pain to some extent, in some medical centers, but across the European continent they failed to support clinical decision making and to improve pain outcomes. Lack of methods to measure and compare outcome quality are a major obstacle for clinicians to assess, and consequently, to improve the consequence of their treatment decisions.
The main objective of the PAIN OUT project is to develop and to validate a system for measurement and feedback of outcome quality and support of decision making which provides the medical community with a unique, user-friendly system to improve quality of postoperative pain management. To increase the benefit of the system to end-users, the registry is complemented with patient data on side effects, quality of life data and treatment costs. Postoperative pain serves as an example for other fields of medicine with a high variation of care.
A core data set to be collected in all participating sites was defined using a Delphi consenting process. A questionnaire was developed, translated and validated in 10 languages, resulting in the International Pain Outcomes questionnaire (IPO). Project implementation in the participating hospitals and staff training for data collection was achieved. The central data base was established successfully. Online web-based data input facilities are fully established.
The main result of PAIN OUT is a web-based information system, featuring three functions:
The EKL draws its information from published guidelines and peer-reviewed studies. For the question of Health Economics in post-operative pain a protocol for the collection of the health economics data was developed. To enhance dissemination, contacts with societies and potential project partners after the funding period have been established. The registry receives data about post-operative patients from the 11 formerly EU-funded participating hospitals across Europe plus a growing number of international hospitals. The central data base was established successfully and contains more than 35,000 patient cases by now.
The PAIN OUT project is the first comprehensive, concerted European effort in the field of improving clinical decision making in the field of pain. It integrates experience gained from a national initiative, and the expertise of world-leading, European-based groups dealing with benchmarking, health outcomes and health care utilization research.
After end of FP7 funding, PAIN OUT is continued as a non-commercial registry project. It’s sustainability is granted by close collaboration with the International Association for the Study of Pain (IASP) and its European chapters, European Federation of IASP Chapters (EFIC), and the European Society of Anesthesiology (ESA). There is remarkable worldwide interest in the project and more than 60 hospitals from all over the world participate in the international branch of the project.
The network of PAIN OUT participants serves as a platform for further research. Already now, adjacent projects (long-term follow-up of PAIN OUT patients, pain management training programme for developing country sites) have been successful set up (funding sources: ESA, IASP).