Fischer Marcelo Rivano, Abbott Allan, Björk Mathilda, Jansen Gunilla Brodda, Göran Gunilla, Stålnacke Britt-Marie, Löfgren Monika
Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden.
Department of Neurosurgery and Pain Rehabilitation, Skanes University Hospital, Lund, Sweden.
Scand J Pain. 2025 May 27;25(1). doi: 10.1515/sjpain-2024-0082. eCollection 2025 Jan 1.
Chronic pain is a major global public-health issue. In Sweden, 20% adults report moderate to severe chronic pain, with 7% continuously seeking healthcare. Shortcomings in treatment, accessibility, and knowledge in healthcare for chronic pain have previously been reported. A generic treatment structure from primary to specialized care and rehabilitation was missing. This study aims to describe the development process for the creation of a person-centered and coherent care (P3C) pathway for adults with chronic pain in Sweden.
A National Action Group with expertise in pain medicine, rehabilitation medicine, psychiatry, anesthesiology, neurosurgery, general medicine, nursing, psychology, physiotherapy, occupational therapy, and patient representation was commissioned to develop the pathway following a stepwise co-designed approach, which included mapping current situation, goals, measures and indicators of the pathway, assessment of consequences and anchoring the process.
Goals were based on challenges identified in the mapping, including improvements in patient's well-being, continuity during and between care contacts, timely self-management, communication between levels of care, and knowledge about pain. Points of pathway entrance and exit were described. Measures focused on areas such as early pain analysis, biopsychosocial approach to assessment and treatment, early rehabilitation plan, teamwork, dialogue and joint plans between levels of care, patient participation, and education on pain and its consequences. Process and outcome indicators, and a report on benefits and risks for patients, ethical aspects, costs, and impacts of the pathway on other areas of healthcare were included.
The P3C pathway addressed the challenges described by patients and practitioners. By being person-centered and coherent, it can promote patient empowerment and equality in care, with emphasis on early and timely interventions, dialogue between patients and practitioners and between levels of care, self-management of pain instead of prolonged medical intervention, value-driven and coordinated care contacts, and increased knowledge about chronic pain, based on existing evidence and experience.
慢性疼痛是一个重大的全球公共卫生问题。在瑞典，20%的成年人报告有中度至重度慢性疼痛，其中7%的人持续寻求医疗护理。此前已有报道称，慢性疼痛的治疗、可及性以及医疗护理方面的知识存在不足。从初级护理到专科护理及康复的通用治疗结构缺失。本研究旨在描述为瑞典慢性疼痛成年人创建以患者为中心且连贯的护理（P3C）路径的开发过程。
一个由疼痛医学、康复医学、精神病学、麻醉学、神经外科、普通医学、护理、心理学、物理治疗、职业治疗及患者代表等领域专家组成的国家行动小组受委托，按照逐步协同设计的方法来开发该路径，其中包括梳理当前状况、路径的目标、措施和指标、后果评估以及确定流程。
目标基于梳理过程中发现的挑战，包括改善患者的幸福感、护理接触期间及之间的连续性、及时的自我管理、护理层级之间的沟通以及对疼痛的了解。描述了路径的入口和出口点。措施集中在早期疼痛分析、生物心理社会评估与治疗方法、早期康复计划、团队合作、护理层级之间的对话与联合计划、患者参与以及关于疼痛及其后果的教育等领域。纳入了过程和结果指标，以及一份关于该路径对患者的益处和风险、伦理方面、成本以及对医疗保健其他领域影响的报告。
P3C路径应对了患者和从业者所描述的挑战。通过以患者为中心且保持连贯，它可以促进患者赋权和护理平等，强调早期和及时干预、患者与从业者之间以及护理层级之间的对话、疼痛的自我管理而非长期医疗干预、价值驱动和协调的护理接触，以及基于现有证据和经验增加对慢性疼痛的了解。
