Digital Chronic Pain Recommendations Map: Consolidation and Systematic Appraisal of Guideline Recommendations Regarding Management of Chronic Pain (e-ChronicPain RecMap)

Article type
Authors
Bravo Soto G1, Busse J1, Cooper L2, Darzi A1, Firas Khalid A3, Guyatt G1, Montalva D1, Ritz S1, Schünemann H1, Swidrovich J4, Torabiardakani K1, Tugwell P5
1Mcmaster University, Hamilton, Ontario, Canada
2Canadian Injured Workers Alliance, Thunder Bay, Ontario, Canada
3York University, Toronto, Ontario, Canada
4University of Toronto, Toronto, Ontario, Canada
5University of Ottawa, Ottawa, Ontario, Canada
Abstract
Background:
Chronic pain affects 1 in 5 individuals; however, patients may receive suboptimal care due to variable guideline quality and inconsistent recommendations.

Objective:
The Canadian Institute of Health Research is supporting the development, dissemination, and evaluation of a freely accessible digital chronic pain recommendation map (e-Chronic Pain RecMap). The RecMap will present consolidated and preappraised recommendations in high-priority areas, including opioids, cannabis for medical purposes, and interventional procedures for chronic pain.

Methods:
(1) We will engage national and international researchers, clinical experts, policymakers, and people with lived experience, including from equity-deserving groups, in developing the RecMap.
(2) We will codesign a team structure with our knowledge users to ensure an efficient and effective workflow. This includes an equity committee and national and international advisory board that will provide consultation throughout the project through a steering committee that will oversee the development and mobilization process.
(3) We will systematically identify guidelines using a screen-scraping approach of specified websites and a rigorous search of electronic databases. We will include relevant guidelines published in any language in the past 5 years and assess their reporting quality using the AGREE-II tool. We will use the predeveloped infrastructure in GRADEPro to extract relevant information including data related to the PROGRESS-Plus framework.
(4) To address divergence, we will use a deductive and inductive approach to establish which recommendations are more trustworthy if reasons for divergence are due to rigor of process. We will also identify if divergence is due to differences in subgroups. Users may then adopt the recommendation(s) that is most trustworthy and relevant to their context.
(5) We will provide plain-language summaries of trustworthy recommendations and decision aids to support patient-physician decision-making and a gateway to contextualizing available guidance.
(6) We will conduct user testing and evaluations regarding awareness, understanding, and uptake of the RecMap in diverse groups.

Anticipated results:
Our freely available RecMap will support shared decision-making and promote evidence-based management of people living with chronic pain. We will report on process, milestones achieved thus far, challenges, and lessons learned.