“It’s about how people deal with their pain”

Chronic pain affects two million people in the Netherlands. Most of them suffer from chronic musculoskeletal pain, with back pain being the most common complaint. These are serious numbers, agrees Jeanine Verbunt. “And yet the impact of chronic pain is somewhat overlooked. Pain is often seen as a symptom rather than a disease. This may change now that the World Health Organisation has classified chronic pain as a disease.”​

Jeanine Verbunt is a professor of Rehabilitation Medicine at CAPHRI and Adelante Zorggroep, a rehabilitation centre. She also works as a consultant in physical medicine and rehabilitation for Adelante at the Maastricht University Medical Centre+. She knows what chronic pain can do to people. “I’m glad that chronic pain is now recognized as a disease, although this could also have a negative effect. Pain is part of growing older. Not all pain can be cured. It’s about how people deal with their pain and how they live with it in such a way that they can continue to function as well as possible. If they can’t get to that point by themselves, they need good rehabilitation care.”

CAPHRI’s research on rehabilitation care for chronic pain is characterized by researchers working closely together with health practitioners. For example, CAPHRI’s Living Lab Rehabilitation and Adelante have established four expertise centres together. One of the centres, the Expertise Centre Pain and Rehabilitation brings together research and teaching on this type of care. Jeanine Verbunt is the research coordinator of the centre. “In our research, we work together with regional parties, from hospitals to primary care providers, as well as with research groups within the academic hospital, such as the pain clinic, orthopaedics and rheumatology.”

Ivan Huijnen is affiliated with the expertise centre as a senior researcher in the Department of Rehabilitation Medicine at CAPHRI. He is also the manager of Center of expertise in Rehabilitation and Audiology, a knowledge centre that forms the Living Lab Rehabilitation together with CAPHRI’s Department of Rehabilitation Medicine. In addition, since January 2023 he is appointed as lector at Zuyd University of Applied Sciences within the Research Centre for Assistive Technology in Health Care. Chronic pain has a significant social impact, says Huijnen, and not just because it prevents people from fully functioning and participating in society. “Ninety per cent of chronic pain symptoms are medically unexplained and cannot be treated. Because of this, patients are not always satisfied with the care they receive and continue to look for other forms of treatment to relieve their pain. This results in very high costs.”

That is why researchers and health practitioners are joining forces to innovate treatments. They’re taking a matched-care approach, explains Jeanine Verbunt. “As we learn more, we develop new treatment plans. Our goal is to help people function as well as possible and achieve the goals they set for themselves. We’re not focused on relieving their pain as much as helping them to deal with it.” As good treatments involve good patient support, the expertise centre established the Network Pain Rehabilitation Limburg. “Patient support in rehabilitation care is quite fragmented and varied at the moment. The same goes for the information patients receive. We want to streamline the patient's support”, says Ivan Huijnen, project leader of the network. The Network Pain Rehabilitation Limburg was a pilot project in southeast Limburg. It involved various health professionals – allied health professionals, general practitioners, and GP assistants focused on mental health care – who worked working closely together. In the network the E-health application SanaCoach Pain Rehabilitation was used to support decision making of the health professional and self-management of the patient by making use of eLearning modules and diaries. The goal of the project was to create a unified vision of how to support and treat chronic pain patients in optimising their functioning despite pain. The organization of care was tailored based on the complexity of the pain complaints and the patient’s needs.  In this project, based on classification tools health care professionals were supported in their decision making. The parties involved worked more closely together and when possible the care was provided closer to home, at a lower level in the health system and when needed the patient was referred to secondary care. In November 2022 Cynthia Lamper defended her PhD thesis (PhD student CAPHRI) entitled: "Network Pain Rehabilitation: an integrated interdisciplinary care approach".

Based on the results of this CAPHRI PhD project, further initiative are started to further improve the organization of care. First, a multidisciplinary rehabilitation treatment in primary care will be implemented in the upcoming months. In this innovative rehabilitation treatment in primary care, the treatment is provided by professionals from different disciplines who work closely together. Based on an innovation rule, this care is in the pilot phase financed and therefore accessible for all patients matching the indication criteria for this treatment. From the living lab, the scientific evaluation will be performed by Kirsty Musch, a second PhD student involved. Another innovatieve initiative based on the results of the Network Pain Rehabilitation Limburg is the implementation of an advice consultation of a consultant in rehabilitation medicine. Based on the opinions of healthcare professionals in primary care and especially the general practitioners, this consultation was recommended to implement to support the general practitioner in the decision making. Patients with more complex complaints seen by the GP can be referred to this consultation to get advice which treatment is recommended based on the patient’s complexity of complaints and/or to give education from a biopsychosocial perspective.  Jeanine Verbunt nods. “That’s why it is important to translate new insights in specialist rehabilitation care into primary care. Care will become more accessible and patients won’t have to visit multiple healthcare providers.” To prevent unnecessary visits, healthcare providers need to work from a broader perspective; an integral view on health. To be able to do that, healthcare professionals need to become more and more familiar with other disciplines and be able to work interdisciplinary.  Also medical and paramedical health care professionals need to collaborate more intensively to provide this integral approach. Therefore, it is an important development that the new lectorate has recently started at the University of Applied Sciences. At these university, the future paramedics are trained and this integral view on health can be introduced during this training.