Theme 1: Which concepts (or “domains”) of chronic pain should be included as “core” in Cochrane summary of findings tables?
| Key Issues Raised by Respondents | No. Respondents (denominator = 36) |
|---|---|
| Pain intensity is an important outcome to present in SoF tables for chronic conditions | 32 |
| • A direct measure of pain, describes the pain experience; the first issue of communicating with HCP | |
| • There is clear and consistent evidence that improving pain results in improvements in fatigue depression, health-related quality of life and function, and work | |
| • Existing consensus on this by IMMPACT (PI measured on a 0–10 NRS) | |
| A 1-dimensional measure of PI alone does not capture the complexity of pain impact | 10 |
| • “This is to me more important: whether it [pain] stopped me from what I wanted to or needed to do rather than something that was just there. Rating the intensity of the pain might be impacted by whether it is preventing me from doing what I want/need to do” (quote from patient) | |
| • The best measure for a trial because it has the best sensitivity to change (i.e., intensity) doesn’t necessarily reflect a meaningful improvement in the patient experience | |
| Consideration of the phrasing and standardization of questions about PI with respect to: | 7 |
| • Time frame (e.g., current, last 24 hours, last month, change from previous time point) | |
| • Type of pain (e.g., average, least, worst) | |
| • Specification of activity (e.g., on movement, on walking, at rest) | |
| • Location (overall or global pain, pain targeted to a joint) | |
| • Recall bias concerns | |
| Difficulties in capturing and measuring the concept of PI | 5 |
| • It is framed by individual experience and tolerance | |
| • It is a qualitative construct that we are trying to quantify | |
| Importance of pain frequency | |
| • Is an important outcome to include in an SoF table | 5 |
| • “It depends” on condition, e.g., important to describe for recurrent/periodic/intermittent pain | 11 |
| Importance of pain interference with function | |
| • Is an important outcome to include in an SoF table | 28 |
| • How does it link or overlap with a measure of function alone? | 2 |
| • Oversimplification that improving pain improves function | 1 |
| Consideration of whether generic or disease-specific pain measures should be reported | |
| • Both | 7 |
| • Prefer generic (“pain is pain”) | 4 |
| • Prefer condition-specific | 3 |
| • Depends on the question and goal of the systematic review | 5 |
| • Generic helps to make comparisons across conditions, but a field may prefer to use condition-specific | 4 |
| Other pain-related domains for consideration: | 15 |
| • Pain duration, pain relief, pain behavior, pain quality, and the effect of pain on fatigue, activities of daily living, worker productivity, health-related quality of life, sexual activities, effect on partners/caregivers | |
| • Should consider both the etiology of the pain condition and the nature of the intervention | |
| Important to include patient perspective in the discussions | 24 |
| • Link with existing OMERACT pain working group and their discussions on pain domains and key issue: Is chronic non-cancer pain a disease in and of itself? | |
| • Consider OMERACT Filter 2.0 framework |
PI: pain intensity; HCP: healthcare practitioner; SoF: summary of findings; IMMPACT: Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials; NRS: numeric rating scale.