Marcelo Rivano Fischer

affiliated with the university, Ph D, Associated Professor

Research

My research taps into several connected branches in need of investigation to improve the efficacy of treatments for chronic pain. Early on I was interested in the use of screening instruments for specific chronic conditions, such as neck pain after trauma, and general screening instruments, such as that that of motivation for change, as well as the use of established inventories to extract useful information as to the factors that point to a general index of outcomes of rehabilitation. Regarding outcomes I participated in research evaluating changes in occupational performance after pain rehabilitation, and how patients experienced physical activity. Furthermore I was interested in exploring the use of CBT for symptom desensitization of patients with similar problems regarding consequences to those of chronic pain patients. 

I was interested to explore the outcomes of rehabilitation programs, mainly long-term outcomes of aspects that helped patients to manage their life and therefore participated in a research group exploring outcomes, such as occupational performance and level of satisfaction with it, psychosocial functioning and disability. This work formed the core of a doctoral thesis (occupational therapist, PhD 2014) where I was assistant supervisor. 

In 2011 I was entrusted to take charge of the national quality registry of chronic pain rehabilitation. As national manager I was interested in promoting pain research using registry data. We launched a national platform for researchers interested in investigating pain related questions using registry data. I participated in a research program investigating patients with a diagnosis related to chronic pain (DRCP) by retrieving data of 840 000 Swedish patientsin Region Västra Götaland. We looked into direct and indirect costs of patients with a DRCP, to determine variation in these costs across different diagnosis groups, and to identify what resources constitute the most important components of costs. These studies exemplified the usefulness of registry studies and served as inspiration for ongoing and planned research that I am participating in. 

In order to enhance the effect size of improvement after chronic pain rehabilitation there have been calls for studies that identify mechanisms through which CBT works (mediators) and patient characteristics that influence their response to these mechanisms and to treatment in general (predictors and moderators). In line with my interest in outcomes I participated in a research group that focused on whether changes in psychological flexibility mediated outcomes in chronic pain CBT based rehabilitation. We investigated also the prevalence of traumatic experiences, trauma types, and PTSD in patients referred for treatment of chronic pain, and the relationship between PTSD and pain-related functioning prior to treatment finding that presence of PTSD in these patients was associated with worse clinical characteristics and increased treatment need. This work formed the core of a doctoral thesis (psychologist, PhD 2018) where I was assistant supervisor.

Ongoing and future research

It has been pointed out that one group of chronic pain patients we know almost nothing about in relation to outcomes of pain rehabilitation is that of patients with not enough knowledge of the native language to participate in pain programs being researched. I collaborated to laund a multicenter study. Preliminary data have been presented and several papers are under preparation.

Another venue to explore in order to enhance positive outcomes of pain rehabilitation is that of the actual components being used in the programs. We analyzed information received from all units participating in the national registry in order to investigate differences in the units’ design of programs, main components, duration and length of stay, in order to allow for future research to make comparisons between relevant programs.

The cost related to chronic pain are mainly related to loss of productivity. Therefore we have been investigating the effects of pain rehabilitation on sick leave patterns of patient in the registry (2007-2011) by tracking their presence in the national social insurance system’s database, one year prior to rehabilitation, at start, at one-year and two-year follow-up. This research agenda will continue by exploring predicting and mediating factors related to the effects of pain rehabilitation on sick leave patterns.

As indicated above, the pharmaceutical treatment of chronic pain is in need of better guidelines. One problem inherent to the more or less uncontrolled use of opioids is that of addiction problems caused by opioid prescriptions. We are investigating this population, both at the clinical setting and nationally. Furthermore we are evaluating the effects of the discontinuation of opioid treatment in patients sent to our Department in a research program that is the core of a doctoral thesis (physician, PhD planned 2020) where I am assistant supervisor.

My current and future research focusses partly on defining subgroups of chronic pain patients, using registry data to describe these groups in a way that is conductive for better treatment, and extending the knowledge we have in treating chronic unspecified pain to patients with chronic pain due to specific pathologies when chronic pain becomes the main problem for patients’ normal life activities. We are investigating what are the components delivered by the units offering pain rehabilitation and papers will be started to be submitted this year. Furthermore I am focusing on investigating the use of technological advances to open new ways for treating chronic pain and the impact of methods used in other disciplines to improve the life quality of persons with chronic pain.

Recent research outputs

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