Chronic Pain Research Research Articles

Adapting the open-source Gen3 platform and kubernetes for the NIH HEAL IMPOWR and MIRHIQL clinical trial data commons: Customization, cloud transition, and optimization

ObjectiveThis study aims to provide the decision-making framework, strategies, and software used to successfully deploy the first combined chronic pain and opioid use data clinical trial data commons using the Gen3 platform. Materials and MethodsThe approach involved adapting the open-source Gen3 platform and Kubernetes for the needs of the NIH HEAL IMPOWR and MIRHIQL networks. Key steps included customizing the Gen3 architecture, transitioning from Amazon to Google Cloud, adapting data ingestion and harmonization processes, ensuring security and compliance for the Kubernetes environment, and optimizing performance and user experience. ResultsThe primary result was a fully operational IMPOWR data commons built on Gen3. Key features include a modular architecture supporting diverse clinical trial data types, automated processes for data management, fine-grained access control and auditing, and researcher-friendly interfaces for data exploration and analysis. DiscussionThe successful development of the Wake Forest IDEA-CC data commons represents a significant milestone for chronic pain and addiction research. Harmonized, FAIR data from diverse studies can be discovered in a secure, scalable repository. Challenges remain in long-term maintenance and governance, but the commons provides a foundation for accelerating scientific progress. Key lessons learned include the importance of engaging both technical and domain experts, the need for flexible yet robust infrastructure, and the value of building on established open-source platforms. ConclusionThe WF IDEA-CC Gen3 data commons demonstrates the feasibility and value of developing a shared data infrastructure for chronic pain and opioid use research. The lessons learned can inform similar efforts in other clinical domains.

Strengthening the pain care ecosystem to support equitable, person-centered, high-value musculoskeletal pain care

Abstract Improving health and wellbeing outcomes for people experiencing chronic musculoskeletal pain requires collective efforts across multiple levels of a healthcare ecosystem. System-wide barriers to care equity must however be addressed (eg, lack of co-designed services; overuse of low value care/underuse of high value care; inadequate health workforce; inappropriate funding models; inequitable access to medicines and technologies; inadequate research and innovation). In this narrative review, utilizing a systems’ thinking framework, we synthesize novel insights on chronic musculoskeletal pain research contextualized through the lens of this complex, interconnected system, the “pain care ecosystem.” We examine the application of systems strengthening research to build capacity across this ecosystem to support equitable person-centred care and healthy ageing across the lifespan. This dynamic ecosystem is characterized by three interconnected levels. At its centre is the person experiencing chronic musculoskeletal pain (micro-level). This level is connected with health services and health workforce operating to co-design and deliver person-centred care (meso-level), underpinned further upstream by contemporary health and social care systems (macro-level context). We provide emerging evidence for how we, and others, are working towards building ecosystem resilience to support quality musculoskeletal pain care: at the macro-level (eg, informing musculoskeletal policy and health strategy priorities); at the meso-level (eg, service co-design across care settings; health workforce capacity); and downstream, at the micro-level (eg, person-centred care). We outline the mechanisms and methodologies utilized and explain the outcomes, insights and impact of this research, supported by real world examples extending from Australian to global settings.

Uneasiness in interdisciplinary research and the importance of metaphors: A case story on building an interdisciplinary chronic pain research team

Interdisciplinary research is increasingly recognized as a key method to tackle complex societal challenges and stimulate creativity to find innovative solutions. Our key goal when starting our collaboration was to come to innovative ways of treating chronic pain. An ambitious goal that requires out-of-the-box and high-risk-high-gain research. However, interdisciplinary research in practice can be uneasy and will not always be successful. This paper describes a case story focussing on the challenges we faced building an interdisciplinary team. One of the most important lessons is that researchers from different disciplines may think they speak a universal ‘language of science’, but a thorough understanding of each other's ways of working, research paradigms, methods, and concepts is necessary before they can start working together on solving scientific questions. In fact, if researchers cannot understand each other's language, they cannot expect patients to understand scientific language either. Lastly, for academics to engage with a non-scientific audience and vice-versa, we need to find and create places to meet and find ways to interact effectively. Language is the medium through which all these interactions take place. It is therefore essential that language takes a central place in the process of collaboration across disciplines, interdisciplinary research, patient participation and public engagement. In this case story, we share our experiences in creating a common language, summarized in five steps (1: creating the team; 2: metaphor-forced introduction to disciplines; 3: creating common ground; 4: outreach; 5: integration). Metaphors play an important role in this process. We will demonstrate how we reflectively progressed through these steps while enhancing interdisciplinarity, (scientific) innovation and public engagement. This five-step journey can be used as a process-tool for any other high-risk-high-gain research team seeking to innovate through interdisciplinarity – with the risk of becoming a brilliant failure.

Brain predicted age in chronic pelvic pain: a study by the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network.

The effect of chronic pain on brain-predicted age is unclear. We performed secondary analyses of a large cross-sectional and 3-year longitudinal data set from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network to test the hypothesis that chronic pelvic pain accelerates brain aging and brain aging rate. Brain-predicted ages of 492 chronic pelvic pain patients and 72 controls were determined from T1-weighted MRI scans and used to calculate the brain-predicted age gap estimation (brainAGE; brain-predicted - chronological age). Separate regression models determined whether the presence of chronic pelvic pain could explain brainAGE and brain aging rate when accounting for covariates. We performed secondary analyses to understand whether brainAGE was associated with factors that subtype chronic pelvic pain patients (inflammation, widespread pain, and psychological comorbidities). We found a significant association between chronic pelvic pain and brainAGE that differed by sex. Women with chronic pelvic pain had higher brainAGE than female controls, whereas men with chronic pelvic pain exhibited lower brainAGE than male controls on average-however, the effect was not statistically significant in men or women when considered independently. Secondary analyses demonstrated preliminary evidence of an association between inflammatory load and brainAGE. Further studies of brainAGE and inflammatory load are warranted.

Mapping UK Pain Datasets to the OMOP Common Data Model: Lessons Learned

ObjectiveChronic Pain is defined as pain lasting for three months or longer and a report by the British Pain Society in 2016 found that 28 million adults live with this condition. Chronic pain research is problematic as it is poorly represented in health data and often in silos. Alleviate is the Advanced Pain Discovery Platform (APDP) Data Hub which is removing barriers to access to data. ApproachThe aim for Alleviate is to transform pain data sets within the UK to be Findable, Accessible, Interoperable and Reusable (FAIR) and be more discoverable for researchers via Health Data Research UK’s Cohort Discovery Tool. The tool enables identification of potential cohorts in real-time from datasets Alleviate provides. The onboarding requires datasets to be transformed to the open and widely used Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). ResultsWe collaboratively developed CaRROT tools and used our mapping expertise to transform datasets to OMOP-CDM. The tools have improved efficient mapping of clinical and research data, covering ~10 million individuals’ records. Subsequently we learned valuable lessons on how to accurately and consistently map across data sets to support federated discovery. We also identified a lack of standard vocabulary representations for pain specific data. ConclusionsMapping data to OMOP is not straightforward. Attention to detail is required to ensure that consistent mapping decisions are made to maximise data reusability and interoperability. ImplicationsIn sharing the lessons learned of mapping datasets to OMOP we aim to help improve interoperability of disparate data sources.

Integrated Approach to Chronic Pain-The Role of Psychosocial Factors and Multidisciplinary Treatment: A Narrative Review.

Chronic non-malignant pain represents a growing global public health priority. Chronic pain is multifactorial, with numerous biological, psychological, and social factors contributing to this pain syndrome. It affects not only the patients, impairing their quality of life, but also their family and social environment. Chronic pain is a diagnosis and requires effective and sustainable treatment strategies. Our aim was to critically review the available evidence on the importance of different approaches in treating patients with chronic non-malignant pain, emphasizing the effectiveness of integrating psychological and social factors within a multidisciplinary framework. This was a non-systematic narrative review of the basic and recent literature analyzing approaches to the treatment of chronic non-malignant pain. The inclusion criteria for the papers were chronic non-malignant pain, treatment approach, review, and original research papers published in English in the last five years (PubMed search), and the basic literature was selected from the references of new papers according to the knowledge and experience of the authors. This literature review included 120 papers, of which 83 were basic, and 37 were new, published in the last 5 years (2018-2023). The results show that both the basic and newly published literature advocate for a biopsychosocial approach to treating chronic pain. New findings, compared to the earlier literature, indicate a new classification of chronic pain into primary and secondary. Chronic pain should be approached with a biopsychosocial model within a multidisciplinary treatment framework. This model addresses the complex interplay of biological, psychological, and social factors, offering a holistic strategy for effective pain management.

Trends in Physiotherapy of Chronic Low Back Pain Research: Knowledge Synthesis Based on Bibliometric Analysis.

Physiotherapy and chronic low back pain (CLBP) form a broad and quickly developing research area. The aim of this article was to holistically, thematically and chronologically analyze and synthesize the literature production in this research area and identify the most prolific research entities and research themes. This article quantitatively and qualitatively analyzed research literature production harvested from the Scopus bibliometric database, using a triangulation of bibliometric and thematic analysis. For this, Excel 2024, Bibliometrix Biblioshiny 4.1 and VOSviewer version 1.6.20 softwares were used. In the Scopus database, 2843 data sources were found, which were published between 1974 and 26 February 2024. The growth trend has been linearly positive since the beginning of publication, and after 2018 exponential growth began. A review of the most prolific entities showed that the most literature was published in America, Europe and Australasia. The thematic analysis of the information sources identified six main themes (pathophysiology of CLBP and the quantification assessment tools, diagnostics and CLBP treatment, CLBP questionnaires and surveys, quality of life, complementary methods in physiotherapy and psychosocioeconomic aspects), while the chronological analysis revealed three main areas of development: assessment tools, CLBP processing and study methodology. The results of this bibliometric study present a good starting point for further research, providing taxonomy and research landscapes as a holistic framework offering multidisciplinary knowledge about CLBP, while chronological analysis provides a basis for identifying prospective research trends. This article offers an interdisciplinary view of the current issue of public health. The results of this study provide a basis for the development of both the physiotherapy and epidemiological fields.

Bibliometric analysis of functional magnetic resonance imaging studies on chronic pain over the past 20 years.

The utilization of functional magnetic resonance imaging (fMRI) in studying the mechanisms and treatment of chronic pain has gained significant popularity. However, there is currently a dearth of literature conducting bibliometric analysis on fMRI studies focused on chronic pain. All the literature included in this study was obtained from the Science Citation Index Expanded of Web of Science Core Collection. We used CiteSpace and VOSviewer to analyze publications, authors, countries or regions, institutions, journals, references and keywords. Additionally, we evaluated the timeline and burst analysis of keywords, as well as the timeline and burst analysis of references. The search was conducted from 2004 to 2023 and completed within a single day on October 4th, 2023. A total of 1,327 articles were retrieved. The annual publication shows an overall increasing trend. The United States has the highest number of publications and the main contributing institution is Harvard University. The journal PAIN produces the most articles. In recent years, resting-state fMRI, the prefrontal cortex, nucleus accumbens, thalamus, and migraines have been researched hotspots of fMRI studies on chronic pain. This study provides an in-depth perspective on fMRI for chronic pain research, revealing key points, research hotspots and research trends, which offers valuable ideas for future research activities. It concludes with a summary of advances in clinical practice in this area, pointing out the need for critical evaluation of these findings in the light of guidelines and expert recommendations. It is anticipated that further high-quality research outputs will be generated in the future, which will facilitate the utilization of fMRI in clinical decision-making for chronic pain.

Co-producing research study recruitment strategies with and for children and young people for paediatric chronic pain studies.

Children and young people experiencing chronic pain are at greater risk of inequitable and poor-quality pain management, which has implications for future management of pain in adulthood. Most chronic pain research is conducted with adults who are more likely to be middle-class, white and monocultured. Inclusive and diverse recruitment practices in paediatric pain research can be an area in which we can address this imbalance of representation. The aim of this current work was to explore these practices and to co-produce recommendations regarding recruitment strategies for paediatric pain research. The research team worked with Your Rheum, a United Kingdom young person's advisory group (ages 11-24 years) and diagnosed with rheumatic condition(s), the opportunity to input into rheumatology research. At a virtual Your Rheum meeting, eight young people (female = 7, male = 1, age range 12-24) took part in group discussions, sharing their experiences of taking part in research and their decision process. Online tools, including Mentimeter and Miro, were used to aid conversations and share ideas. Most young people had experience of taking part in research as a study participant (n = 5). Recommendations synthesised included increased awareness of research in general. The young people discussed being open to hearing about research opportunities; they reflected that they are rarely exposed to these invitations or hear about current research. The clinic environment was highlighted as a "good and trustworthy" recruitment area - being approached by a member of the research team was considered ideal, even if it was someone they had not met previously. Many young people recalled little discussions of research at their clinical appointments. Deciding to participate in research included the following considerations: benefit/impact; connecting with others; research topic; which is then balanced against convenience, and reimbursement. The young people felt that taking part in research was empowering and helped them take ownership of their pain management. It is essential to understand the perspectives of potential study participants, to plan successful recruitment strategies. Ensuring we consider these factors when designing our studies and recruitment strategies is beneficial to all involved. Co-produced recruitment strategies would aid inclusive (and increased) research participation.

Gendered Worlds of Pain: Women, Marginalization, and Chronic Pain

The importance of gender is undertheorized in chronic pain research, meaning extant research cannot sufficiently shed light on how chronic pain experience and treatment are connected to institutions and societal structures. Much literature on gender and pain is not critical in orientation, making it difficult to translate data into recommendations for improved treatment and care. Our study takes a critical approach informed by social theory to understand chronic pain among women who experience socioeconomic marginalization. Drawing on a gender-based subanalysis of interview data collected in Canada as part of an institutional ethnography of chronic pain among people who are socioeconomically marginalized, from women’s narratives, we identified 4 themes that speak to gender, chronic pain, and marginalization. These are 1) gendered minimization of women’s health concerns, 2) managing intergenerational poverty, 3) living with violence and trauma, and 4) gendered organization of family care. Together, these themes highlight how women’s experiences of chronic pain and marginalization amplify gendered vulnerabilities in health care, social services, and society in general. Our findings depict a deeply gendered experience of chronic pain that is inseparable from the daily struggle of managing one’s life with pain with heavy responsibilities, the baggage of past trauma, and responsibility for others with few resources. We emphasize the importance of chronic pain care and health and social services that are both gender- and trauma-informed. PerspectiveThis article draws on an institutional ethnography (a holistic qualitative methodology) of chronic pain and socioeconomic marginalization to demonstrate the importance of chronic pain care and health and social services that are both gender- and trauma-informed.

Studying Health and Illness Experience using Linked Data (SHIELD): Empowering customers to donate shopping data for chronic pain research

Introduction & BackgroundChronic pain is considered a priority in healthcare and a threat to well-being across the globe, it is thus crucial to accurately measure the national levels of pain conditions and their impacts on workplace productivity and well-being. Chronic pain has traditionally been studied in isolation with either self-reported survey data or standalone shopping records. The former are limited in scale and can be marred by response biases, while the latter lack ‘ground truths’: what research teams can measure are usually the purchase patterns of pain relief products, but neither the severity nor types of pain conditions. Objectives & ApproachData donation tools offer a novel approach to study chronic pain by linking the two aspects and establish statistical relationships between medicine consumptions and the multiple facets of pain experience. In a survey, we asked participants (N = 953) to share their loyalty card data with us, which is made possible with the data portability tool provided by Tesco (i.e., the largest supermarket chain in the United Kingdom) as part of the General Data Protection Regulation (GDPR). Based on questions adopted from popular inventories used in health research (e.g., EQ5D Health States, ONS4 Well-being, WEMWBS scales), we also asked participants to report the details of their pain conditions, hours of employment, and both general and mental health states. This allowed us to associate chronic pain - both subjective and objective (i.e., reflected by medicine consumption) - with its economic and personal consequences. Data collection was conducted via research panel providers, thus should approximate national representativeness. Relevance to Digital FootprintsThis work links digital footprints data donated by individuals to self-reported survey data, also develops an infrastructure for these data to be collected and safely stored. Conclusions & ImplicationsOne key value of this project is to pioneer a measure of chronic pain that can be applied to transactional records that are much bigger in scale in future analytic works. Our research team has access to an array of different digital footprints data, including longitudinal transactional data provided by a major pharmacy chain (~20 million customers and ~429 million baskets). In order to utilise these data to associate them with regional workplace productivity measures and well-being data released by the Office for National Statistics, a metric must be defined to extract the prevalence of chronic pain from shopping data, which is informed by the patterns found by the data donation project.

The Role and Applications of Artificial Intelligence in the Treatment of Chronic Pain.

This review aims to explore the interface between artificial intelligence (AI) and chronic pain, seeking to identify areas of focus for enhancing current treatments and yielding novel therapies. In the United States, the prevalence of chronic pain is estimated to be upwards of 40%. Its impact extends to increased healthcare costs, reduced economic productivity, and strain on healthcare resources. Addressing this condition is particularly challenging due to its complexity and the significant variability in how patients respond to treatment. Current options often struggle to provide long-term relief, with their benefits rarely outweighing the risks, such as dependency or other side effects. Currently, AI has impacted four key areas of chronic pain treatment and research: (1) predicting outcomes based on clinical information; (2) extracting features from text, specifically clinical notes; (3) modeling 'omic data to identify meaningful patient subgroups with potential for personalized treatments and improved understanding of disease processes; and (4) disentangling complex neuronal signals responsible for pain, which current therapies attempt to modulate. As AI advances, leveraging state-of-the-art architectures will be essential for improving chronic pain treatment. Current efforts aim to extract meaningful representations from complex data, paving the way for personalized medicine. The identification of unique patient subgroups should reveal targets for tailored chronic pain treatments. Moreover, enhancing current treatment approaches is achievable by gaining a more profound understanding of patient physiology and responses. This can be realized by leveraging AI on the increasing volume of data linked to chronic pain.

Targeting Prefrontal Cortex Dysfunction in Pain.

The prefrontal cortex (PFC) has justifiably become a significant focus of chronic pain research. Collectively, decades of rodent and human research have provided strong rationale for studying the dysfunction of the PFC as a contributing factor in the development and persistence of chronic pain and as a key supraspinal mechanism for pain-induced comorbidities such as anxiety, depression, and cognitive decline. Chronic pain alters the structure, chemistry, and connectivity of PFC in both humans and rodents. In this review, we broadly summarize the complexities of reported changes within both rodent and human PFC caused by pain and offer insight into potential pharmacological and nonpharmacological approaches for targeting PFC to treat chronic pain and pain-associated comorbidities. SIGNIFICANCE STATEMENT: Chronic pain is a significant unresolved medical problem causing detrimental changes to physiological, psychological, and behavioral aspects of life. Drawbacks of currently approved pain therapeutics include incomplete efficacy and potential for abuse producing a critical need for novel approaches to treat pain and comorbid disorders. This review provides insight into how manipulation of prefrontal cortex circuits could address this unmet need of more efficacious and safer pain therapeutics.

Priorities for HIV and chronic pain research: results from a survey of individuals with lived experience

ABSTRACT The Global Task Force on Chronic Pain in HIV published seven research priorities in the field of HIV-associated chronic pain in 2019: (1) causes; (2) management; (3) treatment individualization and integration with addiction treatment; (4) mental and social health factors; (5) prevalence; (6) treatment cost effectiveness; and (7) prevention. The current study used a web-based survey to determine whether the research topics were aligned with the priorities of adults with lived experiences of HIV and chronic pain. We also collected information about respondents’ own pain and treatment experiences. We received 311 survey responses from mostly US-based respondents. Most respondents reported longstanding, moderate to severe, multisite pain, commonly accompanied by symptoms of anxiety and/or depression. The median number of pain treatments tried was 10 (IQR = 8, 13), with medications and exercise being the most common modalities, and opioids being viewed as the most helpful. Over 80% of respondents considered all research topics either “extremely important” or “very important”. Research topic #2, which focused on optimizing management of pain in people with HIV, was accorded the greatest importance by respondents. These findings suggest good alignment between the priorities of researchers and US-based people with lived experience of HIV-associated chronic pain.

Attending to Marginalization in The Chronic Pain Literature: A Scoping Review

ABSTRACT Background There has been a recent and, for many within the chronic pain space, long-overdue increase in literature that focuses on equity, diversity, inclusion, and decolonization (EDI-D) to understand chronic pain among people who are historically and structurally marginalized. Aims In light of this growing attention in chronic pain research, we undertook a scoping review of studies that focus on people living with chronic pain and marginalization to map how these studies were carried out, how marginalization was conceptualized and operationalized by researchers, and identify suggestions for moving forward with marginalization and EDI-D in mind to better support people living with chronic pain. Methods We conducted this scoping review using critical analysis in a manner that aligns with dominant scoping review frameworks and recent developments made to scoping review methodology as well as reporting guidelines. Results Drawing on 67 studies, we begin with a descriptive review of the literature followed by a critical review that aims to identify fissures within the field through the following themes: (1) varying considerations of sociopolitical and socioeconomic contexts, (2) conceptual conflations between sex and gender, and (3) differing approaches to how people living with chronic pain and marginalization are described. Conclusion By identifying strengths and limitations in the research literature, we aim to highlight opportunities for researchers to contribute to a more comprehensive understanding of marginalization in chronic pain experiences.

Estimation of cognitive impairment in chronic pain patients and characteristics of estimated mild cognitive impairment.

Patients with chronic pain suffer from psychological effects such as anxiety due to the pain itself. Pain can not only impair activities of daily living (ADL) and quality of life (QOL), but also impair cognitive function. Therefore, in this study, we aimed to estimate the cognitive function of chronic pain patients using a deep neural network (DNN) model that has already been implemented in society. We investigated the characteristics of patients presumed to have mild cognitive impairment (MCI) and, at the same time, verified the relationship with the questionnaire commonly used in chronic pain research, which is administered by 43 university affiliated hospitals and medical institutions participating in the chronic pain research group of the Ministry of Health, Labor and Welfare in Japan (assessment batteries). The study included 114 outpatients from a multidisciplinary pain clinic, and we estimated their Mini-Mental State Examination (MMSE) scores based on age and basic blood test data (23 items). Furthermore, we classified the estimated MMSE scores of chronic pain patients into two groups based on a cutoff score of 27, which indicates MCI, and compared the blood data and assessment batteries. Additionally, we used a control group of 252 healthy adults aged 45 years or older who visited a dementia prevention outpatient clinic for comparison with the MMSE scores of chronic pain patients. The MMSE scores in chronic pain patients were below the cutoff for MCI. When classified into two groups based on the estimated MMSE score of 27 points, WBC, RBC, Hb, Hct, PLT, UA, BUN, creatinine, Triglyceride, and γ-GT were significantly higher in the blood data. In the MCI group, PDAS values were significantly lower. Furthermore, only in the non-MCI group, a significant correlation was found between the estimated MMSE value and BPI, PDAS, and Locomo. The estimated MMSE scores were significantly lower in chronic pain patients than in healthy adults (p = 0.04). Patients with chronic pain may exhibit cognitive impairment due to systemic metabolic disturbances. This suggests that chronic pain affects activities of daily living, resulting in systemic metabolic disorders.

Pain and the Non-Pharmacological Management of Pain in People with Parkinson's Disease.

Pain is a distressing and universal experience, yet everyone's pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson's disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how pain is classified in Parkinson's disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework.

Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus.

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Validation of Distinct Bladder Pain Phenotypes Utilizing the MAPP Research Network Cohort

Introduction and HypothesisAs interstitial cystitis/bladder pain syndrome (IC/BPS) likely represents multiple pathophysiologies, we sought to validate three clinical phenotypes of IC/BPS patients in a large, multi-center cohort using unsupervised machine learning (ML) analysis.MethodsUsing the female Genitourinary Pain Index and O’Leary-Sant Indices, k-means unsupervised clustering was utilized to define symptomatic phenotypes in 130 premenopausal IC/BPS participants recruited through the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) research network. Patient-reported symptoms were directly compared between MAPP ML-derived phenotypic clusters to previously defined phenotypes from a single center (SC) cohort.ResultsUnsupervised ML categorized IC/BPS participants into three phenotypes with distinct pain and urinary symptom patterns: myofascial pain, non-urologic pelvic pain, and bladder-specific pain. Defining characteristics included presence of myofascial pain or trigger points on examination for myofascial pain patients (p = 0.003) and bladder pain/burning for bladder-specific pain patients (p < 0.001). The three phenotypes were derived using only 11 features (fGUPI subscales and ICSI/ICPI items), in contrast to 49 items required previously. Despite substantial reduction in classification features, unsupervised ML independently generated similar symptomatic clusters in the MAPP cohort with equivalent symptomatic patterns and physical examination findings as the SC cohort.ConclusionsThe reproducible identification of IC/BPS phenotypes, distinguishing bladder-specific pain from myofascial and genital pain, using independent ML analysis of a multicenter database suggests these phenotypes reflect true pathophysiologic differences in IC/BPS patients.

Understanding facilitators of research participation among adults with self-reported chronic pain – a survey examining hypothetical research participation

BackgroundAn inability to successfully recruit participants into clinical research has consequences that negatively affect the conduct and reliability of research studies. Understanding facilitators of research participation, namely motives for participation and preferred research outcomes, may improve recruitment and retention of clinical trials related to chronic pain. The present study explored research participation facilitators among individuals with chronic pain and their association with demographic characteristics, pain-related characteristics, and factors related to future research engagement.MethodsIndividuals from Michigan who were 18 years or older and self-reported having chronic pain completed an online survey assessing motives for research participation and desired research outcomes. Analyses were conducted in three stages. First, we evaluated underlying factors of motives for participation and research outcome preferences using principal components analysis. Second, we classified individuals according to their patterns of facilitators using latent profile analysis. Finally, we evaluated differences between facilitator profiles in demographic characteristics, pain-related characteristics, and factors related to future research engagement using χ2 analyses and Kruskal-Wallis rank sum tests.ResultsThree components of motives for research participation were identified: social engagement/enjoyment; pain improvement/advancing science; and compensation. Three components of research outcome preferences were identified: co-occurring symptom reduction; behavior reduction modification; and pain and function improvement. Four potential patient-centered profiles utilizing these dimensions of facilitators were identified that had unique demographic characteristics, research participation willingness, and treatment interest.ConclusionsOur data provide a framework of motives and research outcome preferences that may inform recruitment and retention in chronic pain research. It also gives an indication of who may respond best to active or passive recruitment strategies that appeal to a given motive or preferred outcome. This information may be useful for improving recruitment and to monitor any potential biases in participant samples.