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How can we improve the care of people with chronic pain presenting frequently to Emergency Departments (EDs)?


The opportunity exists to join a motivated team of clinical researchers aiming to improve the quality of care provided to people facing the challenge of chronic pain. The Pain Pathways Research team of the Pain Management Research Institute (PMRI) is based on the campus of the Royal North Shore Hospital and has dedicated space within the Kolling Institute. The overarching aims of the research project are to examine the identification and care of people with chronic pain attending EDs frequently and provide evidence on how to improve their care. This research will form part of the Pain Management Pathway (PainPATH) study, which aims to establish the effectiveness of a care coordination pathway to support people with chronic pain in the community.


Associate Professor Paul Wrigley.

Research location

North Shore - Kolling Institute of Medical Research

Program type



People with chronic pain who frequently attend NSW Emergency Departments (ED) need access to support services that help them better manage in the community. The PainPATH study is a randomised controlled trial (RCT), underpinned by a process evaluation. Participants in the study will be randomly allocated to intervention (care coordination services) or usual care. The primary outcome of the RCT is a reduction in the frequency of ED presentations for chronic pain related problems. The process evaluation will examine:

1. Implementation: how is delivery of the care coordination pathway achieved, and what is actually delivered? 

2. Mechanisms of impact: how does the delivered intervention contribute to outcomes? 

3. Context: how does context affect implementation of the care coordination pathway and outcomes? (1)

The research project will involve the following: 

1. The conduct of a scoping review (3) on the best methods to identify people with chronic pain presenting frequently to EDs. 

2. Conduct direct observations and interviews with key informants to map the identification process and patient journey of people with chronic pain presenting frequently to EDs (2). This will inform adoption and utilisation of the patient identification process in the ED setting. This will also enable timely triage and appropriate referral for assessment and management of pain to address the root causes of ED presentation rather than just managing the acute episodes of pain. Key informants will include patients as well as staff from the Ministry of Health (System Integration Monitoring and Evaluation and other relevant branches), NSLHD - Analytic data analysis unit responsible for patient identification, NSLHD - Care coordinators and the PainPATH study (Study investigators). 

3. Conduct a systematic review on interventions that assist the management of chronic conditions in the community. This will involve exploring the literature on interventions for people with chronic conditions in general, and people with chronic pain. The review will focus on care integration, self-management support and care coordination. 

4. Collect and analyse qualitative data obtained from care coordination staff, who have provided care to participants of the PainPATH study. This will involve examining the care coordinator acceptance of the PainPATH approach and views and experiences about the 
· pain management skills training they have received 
· application of these skills in care coordination and 
· feasibility of implementing a care coordination pathway to support people with chronic pain. 

5. Collect and analyse qualitative and quantitative data obtained from patients, clinicians and health managers to examine what contextual (patient, clinician and/or organisational) factors influence (prevent OR facilitate) implementation of the care coordination pathway. This will involve examining implementation fidelity, acceptability, feasibility, adaptability and replicability of PainPATH (for scaling up).

Additional information

• Our research team has 4 members (Pain Medicine clinical academic, Medical academic, Experienced Manager and Research Nurse)

• We have an expert team of clinicians working alongside us providing patient care (medical, clinical psychology, physiotherapy and nursing)

• Translational Research: We have active collaborations with colleagues from the PMRI (University of Sydney) with expertise in clinical trial translation (Prof Michael Nicholas, Prof Paul Glare, Dr Dan Costa)

• Health Economics: We have an established collaboration with Prof Deborah Schofield (Distinguished Professor and Chair of Health Economics, Macquarie University). Prof Schofield is guiding the economic analysis of a translational research project examining the value of a healthcare pathway (PainPATH) for people who have frequently attended emergency departments for pain (Ernst Heine Family Foundation, $1.14, 2020-2023),
• The partners on the PainPATH project include the Northern Sydney LHD, Northern Sydney Primary Health Network, Agency for Clinical Innovation, NSW Ambulance and the NSW Ministry of Health. Consumers have been involved in design from inception.

1. Moore G, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, . . . Baird J. Process evaluation of complex interventions: UK Medical Research Council (MRC) guidance: The MRC Population Health Science Research Network, 2014.

2. Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res 2021; 21(1): 342.

3. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology 2018;18(1):143.

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Opportunity ID

The opportunity ID for this research opportunity is 2979