Exploring the complexities of pain phenotypes: OMERACT 2023 chronic pain working group workshop

Tim Pickles; Mary Cowern; Robin Christensen; Sabrina M Nielsen; Lee S Simon; Caitlin M P Jones; Lara J Maxwell; Beverley Shea; Vibeke Strand; Zahi Touma; Karine Toupin-April; Philip Mease; Ernest Choy

doi:10.1016/j.semarthrit.2023.152342

Exploring the complexities of pain phenotypes: OMERACT 2023 chronic pain working group workshop

Semin Arthritis Rheum. 2024 Feb:64:152342. doi: 10.1016/j.semarthrit.2023.152342. Epub 2023 Dec 15.

Authors

Affiliations

¹ Centre for Trials Research, Cardiff University, Cardiff, UK. Electronic address: [email protected].
² Versus Arthritis, UK.
³ Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Copenhagen, Denmark.
⁴ SDG LLC, Cambridge, MA, USA.
⁵ Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
⁶ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁷ The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA.
⁹ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Rheumatology, Toronto Lupus Program, University of Toronto, Toronto, Ontario, Canada.
¹⁰ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Institut du Savoir Montfort, Ottawa, Ontario, Canada.
¹¹ Seattle Rheumatology Associates and Division of Rheumatology Research, Swedish Medical Center, Seattle, WA, USA.
¹² CREATE Centre, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.

PMID: 38128175
DOI: 10.1016/j.semarthrit.2023.152342

Abstract

Objective: To educate and discuss pain mechanisms (nociceptive, neuropathic, nociplastic) illuminating its possible impact when measuring different outcomes, which may modify, confound and potentially bias the outcome measures applied across various aspects of Rheumatic Musculoskeletal Diseases (RMDs) clinical trials.

Methods: In the plenary presentations, PM lectured on different pain mechanisms and impact on disease activity assessment. Data from two data sets of RMDs patients, which assessed the prevalence and impact of nociplastic pain were presented and reviewed. Audience breakout group sessions and polling were conducted.

Results: Mixed pain etiologies may differentially influence disease activity assessment and therapeutic decision-making. Polling demonstrated a consensus on the need to assess different types of pain as a phenotype, as it constitutes an important contextual factor (a variable that is not an outcome of the trial, but needs to be recognized [and measured] to understand the study results), and to standardize across RMDs.

Conclusion: There is need for a standardized pain measure that can differentiate underlying pain mechanisms.

Keywords: Chronic pain; Measurement; Neuropathic; Nociceptive; Nociplastic; OMERACT.

MeSH terms

Chronic Pain* / therapy
Humans
Musculoskeletal Diseases*
Outcome Assessment, Health Care
Rheumatic Diseases* / therapy
Rheumatology*