Dive into Science with the Relief project

Eullia Hernndez-Encuentra and Manuel Armayones-Ruiz
Problems don't have just one solution

Reading time: 10 minutes

This series is offered by researchers, science communicators and academic staff working together to bring you into closer contact with science. The “Dive into Science Week with UOC Researchers” series combines the UOC’s online expertise with the offline events organized for Science Week to create an online slow-reading experience. For Science Week 2017, we’ll share scientific knowledge on e-learning, eHealth, digital humanities, and ICTs in social science. Today we highlight the eHealth research carried out through the Horizon 2020-funded Relief project.

What is the best number of solutions to a problem? A single, unique solution, so you feel like you are doing the right thing? Two, just to have a choice? Three, to have an odd number to help tie the vote? Maybe any number of them, to have a range of options from which to choose the solution that best fits you?

No one dare say that research is not important, even those who brand researchers as people living with their heads in the sand, spending public money to work on a topic that is only of interest to them. Even then, research is considered a method for improving knowledge, in other words, of going further. Fortunately, there is a widespread belief that research is not only the way forward, but also a key approach in providing solutions to society’s problems: problems that worry, burden and compromise people’s quality of life, such as chronic pain.

Chronic pain is a common, burdening and complex issue that has not been addressed sufficiently

Do you know anyone who has never felt pain? Can you imagine no one ever feeling pain again? Do you know what chronic pain is, or what the difference between chronic and acute pain is?

Find out by watching this video. It takes less than five minutes!

It is estimated that around 95 million Europeans suffer from chronic pain (it varies across the EU, but figures range from 19% to 27% of the adult population). Chronic pain is defined as pain that lasts for longer than 3 to 6 months, or beyond the normal healing time of an injury. Can you imagine suffering from persistent pain for three to six months? And this pain is accompanied inevitably by other psychosocial aspects like sleep and eating disorders, emotional distress, fatigue, social isolation, absences from or inability to work, etc. What’s more, its impact will not only be felt by you, the person in pain, but also by your family, friends, work colleagues and even society as a whole.  Chronic pain seriously affects the personal, social and working lives of people, not to mention the high cost it brings with it in terms of health care and the economy.

“We are educating our medical students in only 0.2 per cent of their studies on how to deal with one of the most frequent problems they will encounter in medical practice: pain.” —Prof. Hans G. Kress, MD, PhD. Immediate Past President of the EFIC (European Pain Federation)

According to the scientific literature and both the International Association for the Study of Pain (IASP) and the European Pain Federation (EFIC) representatives, an appropriate policy response to chronic pain is lacking, despite its high degree of impact and even though pain treatment is recognised as a human right by international resolutions.

One reason for this could be that chronic pain is a complex issue, the treatment of which may require primary and specialized care (in pain clinics or in pain centres, the latter differing from the former only in terms of its teaching and research role). Perhaps it is because it calls for a multidisciplinary approach that implies coordinating physical therapy, psychological therapy and rehabilitation programmes. In either case, high costs are implied.

Therefore, even though existing evidence supports these approaches, it is not a widespread reality, because not everyone has access to specialized pain care. This means that chronic pain is often treated by primary care physicians who find this very challenging, especially because they do not have the appropriate training.  

All in all, we are faced with a lack of effective treatment for chronic pain.

Turning a problem into an opportunity to innovate

Wherever there is a problem to be solved, a need to be met or a situation to be improved, there is room for research. Within this context, we as researchers have the opportunity to contribute to solving – or trying to solve – a problem, in this case a biomedical, psychosocial and economic problem that needs to be addressed properly. How do we go about this?

First, we need to define accurately what it is what it we need to face and what the specific requirements are that we have to meet. This is essential if we are to provide a useful, ethical, safe, and secure answer.  Second, we must open our minds to look for innovative solutions that truly meet the needs previously identified. This implies being ready to adopt any changes in tools, players, services, processes and procedures should they be feasible and of any help.  

However, innovation in research is not simply a matter of the results it gives as a product; innovation in research is also a matter of design, of the processes by which it is carried out.  And this is where the Relief project comes in.

The Relief project, an example of process and product innovation

The Rielief project, Recovering Life Wellbeing through Pain Self-Management Techniques Involving ICTs, searches for new technologies to assist chronic patients in self-managing their pain through the use of ICTs. It aims to help chronic patients to continue to live independently at home despite any physical disabilities. So, here the word “relief” means the alleviation of not only pain, but also of the disabilities caused by it.

The Relief project searches for an innovative product

Currently, chronic pain management is being addressed by health care providers. However, there is still room for innovation in various aspects.

First. Chronic pain is a major public health concern that deserves a specific care model – a chronic care model – different from the current model for treating acute conditions. This model has to be both effective and cost-effective.

Second. Beyond the traditional model focused on medical treatment/healing, a chronicity model seeks to prevent deterioration and to promote quality of life and wellness throughout the course of one’s life. This requires adopting a self-management perspective that confers an active and responsible role upon the person living in pain. It also implies actively engaging the patient’s family, clinicians, and the community as a whole in cooperative alliance.

Third. Although there are some pain units and pain centres, they are not available to everyone.

Forth. Evidence shows that ICTs are useful tools for chronic pain self-management; however, they are not implemented widely.

Fifth and above all. Relief seeks to provide certain specific needs with an innovative solution, namely improving the patient’s state of mind (psychosocial dimensions of chronic pain) and patient-professional communication; facilitating the reception of reliable information; making it easy to monitor the treatment process (pharmacological and non-pharmacological); and improving adherence to the treatment.

The solutions currently available for the treatment of chronic pain do not offer a product that perfectly responds to the needs identified by the Relief project. Therefore, the final product must be innovative.

The Relief project is being developed using innovative processes

Relief is a pre-commercial procurement (PCP) tender. What does PCP mean? In essence, PCP is a method for stimulating a new solution based on demand through public procurement. The PCP trajectory consists of different phases: accurately defining the needs to be met and the requirements of the new solution/product; holding a call to tender open to the market so that the private companies can send their proposals; prototyping the proposals selected; and, finally, developing a small-scale test of the solutions selected in a second round. This brings the solutions up to the stage where the products are ready for commercialization (which is the public procurement of innovative solutions, or PPI, method). That is, PCP is the research and development phase of product innovation.

Thus, the PCP method implies:

Innovation based on demand, not on offer (normally it is the other way around, where the private sector offers a finished product to be adopted/bought by the institutions).

Collaboration and commitment between the public sector (which, as a procurer, defines a demand and holds a call for tender, develops different solutions and commits to implementing the best one) and the private sector (which, as a supplier, presents and develops a new product).

Introducing innovation into the public sector (which is not as common as it should be).

Finally, instead of putting all the eggs in one basket, PCP entertains multiple solutions and supports a final selection from among the options.

By using PCP methods, are we still talking about Relief as a research project?

Yes, we are. However, it may take a bit of a different shape, because here research is not only about going further in a specific field or about being applied in its final stage. Instead, it is a process completely developed from scratch by contextualizing needs to be met. Let us look at five reasons that back up Relief as a research project.

First. There has been a systematic and ecological (meaning on-site) identification of unmet needs in chronic pain management from the point of view of both health care professionals and patients.  This process was conducted in three health care service centres located in Sweden (a pain centre at the Uppsala University Hospital), Spain (a pain unit at the Reina Sofa University Hospital, Crdoba), and France (the Centre Hospitalier Universitaire Saint-Louis Lariboisire Fernand-Widal, Paris), where the field-testing of final solutions will take place.

Second.  This challenge has been dealt with by using several methodologies with different stakeholders to collect relevant insights, information and concurrent validation (health care providers, patients, chronic pain organizations, eHealth care providers, eHealth policymakers, etc.).

Third. Relief includes a deep analysis of several proposals submitted to the tender according to a set of previously published criteria.

Fourth. It also includes the tracking in the field of the prototypes’ development and testing to assure that they properly matched unmet needs.

Fifth and above all. Relief includes research at two levels: one aimed at offering solutions for a specific situation (chronic pain management), and the second aimed at applying the research background of the Relief team to the submitted projects.

Relief is a collaborative project. It comprises research institutions, consultancies and public sector organizations, each one providing its own expertise. By stimulating the development of multiple innovative solutions, the consortium, as a whole, aims to achieve the same goal: improving chronic pain management and thus the quality of life of citizens around Europe. An ambitious objective, but more than worth it.

RELIEF was awarded  by the Spanish Society of Pain (SED) as the 2016 most innovative initiative for pain. The project has received funding from the European Union’s Horizon 2020 programme under grant agreement no. 689476. and is coordinated by Bravosolution company.