Issues related to optimizing chronic non-cancer and disability management

Abstract

Chronic non-cancer pain (CNCP) is a complex phenomenon that affects multiple dimensions of daily life. Optimal therapies for managing CNCP must, then, demonstrate clinically important benefits that go beyond reductions in pain and adverse events. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) has recommended that clinical trialists who are evaluating treatments for chronic pain consider reporting treatment effects across nine patient-important outcome domains. This thesis begins with an investigation of the extent to which clinical trials evaluating the effects of opioids for CNCP report IMMPACT-recommended core outcome domains. Further, it explores optimal therapeutic strategies for specific CNCP conditions; specifically, it features a systematic review of randomized controlled trials of all pharmacological and non-pharmacological therapies for central post-stroke pain, as well as a plan for a network meta-analysis of all therapies for all chronic neuropathic pain syndromes. Chronic pain is also a common reason for disability, and this thesis concludes with a retrospective cohort study focused on identifying predictors of claim duration following acceptance for disability benefits among Canadian workers.