Translating clinical trials into improved real-world management of pain: convergence of translational, population-based, and primary care research

摘要

1. Introduction: Many strategies may guide improved pain treatment. Among these are (1) translational research (eg, clinical trials of novel therapies emerging from basic science); (2) population research (eg, identify pain burden-pain care health service gaps and describe treatment harms); and (3) primary care research (eg, describe patient presentation/referral patterns and treatment preferences/goals and develop patient care models/pathways). As in Figure 1, convergence of these strategies can help determine who needs treatment, whether treatments are effective, and how to administer treatments. Evidence from randomized controlled trials (RCTs) guides early implementation of new treatments and represents the translational link between preclinical research and patient care.23,29,56,65,98 Controlled phase 1, 2, and 3 RCTs demonstrate safety and efficacy to justify marketing approval of new treatments.24,33,36,99,100 Knowledge synthesis of multiple RCTs of a treatment, for example, systematic reviews and meta-analyses, facilitates evidence-based clinical decisions.60,66,69 "Evidence-based medicine" facilitates treatment selection based on consideration of all available safety and efficacy evidence, sometimes including noncontrolled studies and expert opinion.28,40,42,81