Associate ProfessorPaul Wrigley

Project Opportunities

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

Summary of opportunity:

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.

Opportunity synopsis:

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).

----------Current Research Projects----------

I am the principle investigator of a study establishing the effectiveness and value of a care coordination pathway called the Community Pain Management Pathway (CommunityPainPATH). This multi-agency, consumer informed care pathway aims to support people with chronic pain to better manage in the community reducing their need to seek assistance from Emergency Departments (Heine Foundation: $1.14M, 2020-2023).

Other significant projects I have been chief investigator on include an early intervention study for injured workers (icare Foundation: $1.5M, 2018-2021) and a study examining the long-term neural effects of spinal cord stimulation (ANZCA, Profield: $500K, 2017-2019).