Optimizing and Accelerating the Development of Precision Pain Treatments for Chronic Pain: IMMPACT Review and Recommendations

Edwards, Robert R.; Schreiber, Kristin L.; Dworkin, Robert H.; Turk, Dennis C.; Baron, Ralf; Freeman, Roy; Jensen, Troels Staehelin; Latrémolière, Alban; Markman, John D.; Rice, Andrew S.C.; Staud, Roland; Tate, Simon; Woolf, Clifford J.; Andrews, Nick; Carr, Daniel B.; Colloca, Luana; Cosma-Roman, Doina; Cowan, Penney; Diatchenko, Luda; Farrar, John T.; Gewandter, Jennifer S.; Gilron, Ian; Kerns, Robert D.; Marchand, Serge; Patel, Kushang V.; Simon, Lee S.; Tockarshewsky, Tina; Vanhove, Geertrui F.; Vardeh, Daniel; Walco, Gary A.; Wasan, Ajay D.; Wesselmann, Ursula

doi:10.1016/j.jpain.2022.08.010

Cited by 42 publications

(32 citation statements)

References 227 publications

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“…The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) has proposed different phenotypes and potential mechanisms contributing to chronic pain to be considered for identifying which treatments could be more effective for patients with specific characteristics (Edwards et al, 2022). Hence, identification of the dominant pain phenotype in patients with post-COVID pain could help clinicians to adopt therapeutic strategies resulting in more successful outcomes.…”

Section: Painmentioning

confidence: 99%

Precision management of post‐COVID pain: An evidence and clinical‐based approach

Fernández‐de‐las‐Peñas

Nijs

Giordano

et al. 2023

European Journal of Pain

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BackgroundPain after a SARS‐CoV‐2 acute infection (post‐COVID pain) is becoming a new healthcare emergency but remains underestimated and most likely undertreated due to a lack of recognition of the phenomenon and knowledge of the underlying pain mechanisms. Evidence supporting any particular treatment approach for the management of post‐COVID pain is lacking. Large variability in the patient response to any standard pain treatments is clinically observed, which has led to calls for a personalized, tailored approach to treating patients with chronic post‐COVID pain (i.e. ‘precision pain medicine’). Applying the global concerted action towards precision medicine to post‐COVID pain could help guide clinical decision‐making and aid in more effective treatments.MethodsThe current position paper discusses factors to be considered by clinicians for managing post‐COVID pain ranging from identification of the pain phenotype to genetic consideration.ResultsThe ability of clinicians to phenotype post‐COVID pain into nociceptive, neuropathic, nociplastic or mixed type is suggested as the first step to better planification of a treatment programme. Further, the consideration of other factors, such as gender, comorbidities, treatments received at the acute phase of infection for onset‐associated COVID‐19 symptoms, factors during hospitalization or the presence of emotional disturbances should be implemented into a treatment programme.ConclusionsAccordingly, considering these factors, management of post‐COVID pain should include multimodal pharmacological and non‐pharmacological modalities targeting emotional/cognitive aspects (i.e. psychological and/or coping strategies), central sensitization‐associated mechanisms (i.e. pain neuroscience education), exercise programmes as well as lifestyle interventions (e.g. nutritional support and sleep management).SignificanceThis position paper presents an evidence‐based clinical reasoning approach for precision management of post‐COVID pain.

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Section: Painmentioning

confidence: 99%

Precision management of post‐COVID pain: An evidence and clinical‐based approach

Fernández‐de‐las‐Peñas

Nijs

Giordano

et al. 2023

European Journal of Pain

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“…Other clinical characteristics of the patients may be predictive of treatment response. In particular, some studies have suggested that the severity of sleep disturbances, depression, anxiety or catastrophizing at baseline may predict treatment responses in patients with neuropathic pain (Edwards et al, 2022). For example, post hoc analyses of pooled data from several studies of pregabalin showed that sleep disturbances were among the best predictors of its analgesic effects (Vinik et al, 2013(Vinik et al, , 2014.…”

Section: Other Potential Clinical Markersmentioning

confidence: 99%

“…spontaneous continuous pain, spontaneous paroxysmal pain) and signs (e.g. sensory deficits, mechanical and/or thermal allodynia/hyperalgesia), potentially reflecting pathophysiological mechanisms, may be a relevant strategy (Attal et al, 2011; Baron et al, 2012, 2022; Bouhassira & Attal, 2016, 2019; Colloca et al, 2017; Edwards et al, 2016, 2022; Forstenpointner et al, 2018). Several approaches have been used to identify these sensory profiles or phenotypes in clinical trials, including standardized sensory bedside examination, QST and questionnaire‐based patients reported outcomes (PROs), but there is no clear consensus about the optimal approach as yet.…”

Section: Clinical Markersmentioning

confidence: 99%

“…Attal et al, 2002, 2004; Bouhassira et al, 2021b; Hincker et al, 2019; Kalliomäki et al, 2013). Thus, as advocated by many experts in the field (Baron et al, 2012, 2022; Bouhassira & Attal, 2019; Colloca et al, 2017; Edwards et al, 2016, 2022), major improvements in the management of neuropathic pain will probably depend on the development of new approaches facilitating personalized treatment.…”

Section: Introductionmentioning

confidence: 99%

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Personalized treatment of neuropathic pain: Where are we now?

Bouhassira

Attal

2023

European Journal of Pain

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BackgroundThe treatment of neuropathic pain remains a major unmet need that the development of personalized and refined treatment strategies may contribute to address.DatabaseIn this narrative review, we summarize the various approaches based on objective biomarkers or clinical markers that could be used.ResultsIn principle, the validation of objective biomarkers would be the most robust approach. However, although promising results have been reported demonstrating a potential value of genomics, anatomical or functional markers, the clinical validation of these markers has only just begun. Thus, most of the strategies documented to date have been based on the development of clinical markers. In particular, many studies have suggested that the identification of specific subgroups of patients presenting with specific combinations of symptoms and signs would be a relevant approach. Two main approaches have been used to identify relevant sensory profiles: quantitative sensory testing and specific patients reported outcomes based on description of pain qualities.ConclusionWe discuss here the advantages and limitations of these approaches, which are not mutually exclusive.SignificanceRecent data indicate that various new treatment strategies based on predictive biological and/or clinical markers could be helpful to better personalized and therefore improve the management of neuropathic pain.

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“…There is an increased emphasis on nonpharmacologic interventions that focus on the biopsychosocial components of pain ( 22 ). Many investigators are seeking to identify biochemical ( 23 ) and phenotypic ( 24 ) biomarkers to guide a precision medicine approach targeting the right treatment at the right dose to the right patient at the right time. Ultimately, if we hope to achieve greater success in discovering effective treatments for chronic pain compared with those of the past six decades, it will depend on an entire disruption of the drug discovery strategies of the past.…”

Section: Future Opportunitiesmentioning

confidence: 99%

Discovering chronic pain treatments: better animal models might help us get there

Taylor¹,

Ferrari²

2023

Journal of Clinical Investigation

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Optimizing and Accelerating the Development of Precision Pain Treatments for Chronic Pain: IMMPACT Review and Recommendations

Cited by 42 publications

References 227 publications

Precision management of post‐COVID pain: An evidence and clinical‐based approach

Precision management of post‐COVID pain: An evidence and clinical‐based approach

Personalized treatment of neuropathic pain: Where are we now?

Discovering chronic pain treatments: better animal models might help us get there

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