Academic Center for Pain Medicine

Being an (inter)national leading University Center for Pain Medicine – Nerve damage Delivery of high quality and effective specialized pain managements in specialized and primary care, based on individual patient characteristics, for complex pain and nerve damage problems. Delivery of education and training on an excellent level. International top position in epidemiological, translational and clinical research.

Academic Center of Excellence

Research Activities

Activities by the ACE which take place at the moment are: Translational innovative research on the optimization of nerve reconstruction techniques. Clinically pathophysiologic, diagnostic and therapeutic studies on nerve damage and nerve compression.

Epidemiologic (incidence, prevalence, predictors of outcome), pathophysiologic (neuro-immunological aspects), diagnostic (biomarkers) and therapeutic (neuromodulation, biologicals, cognitive behavioral) studies on Complex Regional Pain Syndrome. Broader there is research on neuropathic pain syndromes in general (epidemiological, basic, translational, and clinical research).

There are epidemiologic (predictors), diagnostic (clinical examination) and therapeutic (minimal invasive, multidisciplinary training programs, pharmacological) studies on low back and neck pain and sciatica (clinical and epidemiological).

The future partners in this ACE have already a good track record in smaller cooperation's within the Erasmus MC. International collaboration exists with top institutes such as George Institute, University of Sydney, Australia, Keel University, UK ; Mayo Clinic, USA and the Cochrane collaboration. Individually or in smaller cooperation the partners of the ACE are already successful in the field of pain medicine and nerve damage. An ACE on pain medicine and nerve damage will improve cooperation further on. This has to result in better visibility of the topic of the ACE and ErasmusMC as a whole to all the stakeholders of Erasmus MC and the development of new research programs and acquirement of new and bigger funds.

Type of

Collaborations

International collaboration exists with top institutes such as George Institute, University of Sydney, Australia, Keel University, UK ; Mayo Clinic, USA and the Cochrane collaboration. Individually or in smaller cooperation the partners of the ACE are already successful in the field of pain medicine and nerve damage. An ACE on pain medicine and nerve damage will improve cooperation further on.

Educational

Contributions

All the future partners in the ACE have already developed education programs in Ba, MSc, residents and fellow's, PhD, (specialist) nurse training programs, General Practitioners (GP) Musculoskeletal disorders training course. The fellow program of the center of

Pain medicine is international with students from e.g. Belgium, Ireland, UK, Germany. Cooperation of the future partners of this ACE in education has to result in innovation and new development of education in Pain medicine and nerve damage. Continues quality improvement based on feedback (e.g. SET Q, D-RECT, visitation and audit reports) is already used, but more in general in the mother specializations involved in this ACE, e.g. Plastic and Reconstructive Surgery: education of BA and MSc students, residents and fellows.

Training is controlled using visitations, SETQ and DIRECT. These reports are available. Development of quality improvement directly focused on education in the field of Pain medicine and nerve damage will be one of the future deliveries of this ACE.

Patient

Care Activities

The Center of Pain Medicine works together with LUMC, UMCU, Havenziekenhuis and Viktoriakliniek. Choices in care are made based on the ROBIJN model and market potential. Despite these choices it seems that based on the first measurements, the Center of Pain Medicine currently does not fulfill the 80% norm. This is partly a result of way of reporting and partly the result of an ongoing process of shift to tertiary care, which is not finished yet.

The department of Plastic and Reconstructive Surgery currently has a 74% Robijn label regarding nerve related patient care. Here, patients are treated starting from the ER / outpatient clinic to a full recovery in the healthcare unit "Motion" (together with the orthopedic surgery and trauma surgery units).

The department of Neurology and Neurosurgery seem to fulfil already the 80% norm for the relevant diagnosis's of this ACE. The ACE as a whole will continue the process to fulfill in the next 5 years the 80% Robijn norm. Clinical multidisciplinary pathways for Oncologic pain, Complex Regional Pain Syndrome and Neuromodulation are already developed. Participation in the Erasmus MC program "value based health care has to be developed within the next 5 years.

A first step, namely the building of an infrastructure for PROM's is already developed and running eg, quality system neuromodulation Netherlands. Quality and educational visitations are fulfilled on a regular base, but focused on the mother specializations. In the next 5 years more pain medicine and nerve damage focused visitations have to be developed. There is already an implementation system to implement research results in daily care and education programs.

Societal Relevance to Research, Education and Patient Care

In the Center of Pain Medicine, epidemiologic research is used for improvement of quality of care (Epidemiology of chronic pain in the Netherlands project, data used for report on chronic pain for Zorg Instituut Nederland and VWS) and has been the fundament for the development of a standard of care for chronic pain in the Netherlands; New knowledge developed by the ACE will continuously be used and included in clinical guidelines, e.g. those by the Dutch College of general Practitionars (NHG standaarden). In a cooperation between the Center of Pain Medicine and the department of family medicine a (cost)effective study is performed on the treatment of low back pain.

The study is performed within a "Voorwaardelijke toelating traject reguliere zorg". The results are used for decision making for reimbursement. In a cooperation between the Center of Pain Medicine and the department of Neurology of LUMC, a new (cost) effective study is started which looks at the treatment of pharmacological intractable chronic cluster headache with neuromodulation.

This is again a study which is performed within a "Voorwaardelijke toelating traject reguliere zorg". The results are used for decision making for reimbursement. Plastic and Reconstructive Surgery: involvement in the Dutch guideline for Carpal Tunnel Syndrome. Also a simple predictive model was created to estimate the severity of nerve trauma and the regenerative potential.

Viability of Research, Education and Patient Care

Within the individual departments of this ACE, there is already a continues recruitment of high potential BA and MSc students from the medical school of Erasmus MC to get them involved in research projects. The best and most talented students are invited for combined projects in which they do a PhD and a residency in a specific specialization, that includes GP training. Outstanding PhD students are motivated to continue their career in an academic position.

Leadership programs are offered for talented members of staff. Despite all these efforts there is a general feeling within the ACE, that this process can be improved. Cooperation within the ACE will make the area more attractive for high potential Ba and MSc students. Combined programs for PhD students in cooperation with Nihes and mastership neuroscience can be developed.

There is already an international cooperation with top institutes e.g. Pain medicine with McGill University Montreal for research on Complex Regional Pain Syndrome, Plastic and Reconstructive Surgery with the Mayo clinic, the Center of Pain Medicine with the faculty of pain medicine college of anesthetists of Ireland for a fellow program, and the George Institute, Sydney. The department of Plastic and Reconstructive Surgery has an international cooperation with the Mayo Clinic (Rochester, MN, USA) to explore the regenerative potential in nerve reconstruction when using an allograft.

Key and relevant publications of the last five years

  • Demographic and medical parameters in the development of complex regional pain syndrome type 1 (CRPS1): prospective study on 596 patients with a fracture. Beerthuizen A, et al. Pain. 2012 Jun;153(6):1187-92
  • A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain Liem L. et al. Neuromodulation 16,5 471-482
  • Surgical management of neuroma pain: a prospective follow-up study. Stokvis A. Et al. Pain 2010;151:862-869.
  • Prognostic factors for outcome after median, ulnar, and combined median-ulnar nerve injuries: a prospective study. Hundepool C. Et al. J Plast Reconstr Aesthet Surg 2015;68:1-8.
  • A new approach to assess the gastrocnemius muscle volume in rodents using ultrasound; comparison with the gastrocnemius muscle index. Nijhuis T. et al. PLoS One 2013;8:e54041.
  • The effect of stem cells in bridging peripheral nerve defects: a meta-analysis. Hundepool C. et al. J Neurosurg 2014;121:195-209.
  • Investigating Reports of Complex Regional Pain Syndrome: An Analysis of HPV-16/18-Adjuvanted Vaccine Post-Licensure Data. Huygen F et al. EBioMedicine. 2015 Jul 6;2(9):1114-21
  • Spinal autofluorescent flavoprotein imaging in a rat model of nerve injury-induced pain and the effect of spinal cord stimulation. Jongen JL et al. PLoS One. 2014 Oct 3;9(10):e109029.
  • Magnetic resonance imaging in follow-up assessment of sciatica; Barzouhi A el at al.N Engl J Med 2013;368(11):999-1007; 2013; [IF 51,658]
  • Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis; Pinto R. et al. BMJ 2012;344:e497; 2012;

PhD theses of the last five years

  • Van Seventer R. Neuropathic pain, back to the patient 2011
  • Dirckx M. CRPS, an inflammatory disease 2015
  • Liem L Stimulation of the DRG fort he treatment of chronic pain 2016
  • De Kruijf M. A journey full of pain trough the general population 2016
  • Maas E. Costeffectiveness of radiofrequency for chronic lowbackpain 2016
  • Stokvis, A. Surgical Management of Painful Neuromas. 2014
  • Nijhuis, T. Bridging the Gap in Relation to Nerve Injury. 2013
  • Verwoerd A. ‘Diagnosis and prognosis of Sciatica’ 2015
  • Enthoven W. ‘Backpain in older adults: subgr and healthcare utilization’ 2015
  • Koopman J. The Epidemiology of Facial Pain 2010

Non-scientific publications related to the ACE

Principal coordinator(s)

Last updated: 365 days ago.