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Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations
Open accessAbstract
There is tremendous interpatient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for “precision medicine” or personalized pain therapeutics (ie, empirically based algorithms that determine the optimal treatments, or treatment combinations, for individual patients) that would presumably improve both the clinical care of patients with pain and the success rates for putative analgesic drugs in phase 2 and 3 clinical trials. However, before implementing this approach, the characteristics of individual patients or subgroups of patients that increase or decrease the response to a specific treatment need to be identified. The challenge is to identify the measurable phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics. In this article, we present evidence on the most promising of these phenotypic characteristics for use in future research, including psychosocial factors, symptom characteristics, sleep patterns, responses to noxious stimulation, endogenous pain-modulatory processes, and response to pharmacologic challenge. We provide evidence-based recommendations for core phenotyping domains and recommend measures of each domain.
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“the presence of a supportive partner has been associated with reduced symptom burden (including less pain), improved quality of life, and fewer symptoms of distress in patients with chronic lymphocytic leukemia 92, metastatic breast cancer 93, 94, and other cancer types such as colorectal cancer95, 96.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [93]
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Metadata
- Authors
- Edwards, R. R., Dworkin, R. H., Turk, D. C., Angst, M. S., Dionne, R., Freeman, R., Hansson, P., Haroutounian, S., Arendt-Nielsen, L., Attal, N., Baron, R., Brell, J., Bujanover, S., Burke, L. B., Carr, D., Chappell, A. S., Cowan, P., Etropolski, M., Fillingim, R. B., Gewandter, J. S., Katz, N. P., Kopecky, E. A., Markman, J. D., Nomikos, G., Porter, L., Rappaport, B. A., Rice, A. S. C., Scavone, J. M., Scholz, J., Simon, L. S., Smith, S. M., Tobias, J., Tockarshewsky, T., Veasley, C., Versavel, M., Wasan, A. D., Wen, W., & Yarnitsky, D.
- Affiliations
- Harvard University (US)
- University of Rochester (US)
- University of Washington (US)
- Stanford University (US)
- East Carolina University (US)
- Oslo University Hospital (NO)
- Washington University in St. Louis (US)
- Aalborg University, Aalborg, Denmark
- Inserm (FR)
- Christian-Albrechts-Universität zu Kiel (DE)
- MetroHealth Medical Center (US)
- Depomed (United States) (US)
- University of Maryland, Baltimore (US)
- Tufts University (US)
- Eli Lilly (United States) (US)
- American Chronic Pain Association (US)
- Johnson & Johnson (United States) (US)
- University of Florida (US)
- Collegium Pharmaceutical (United States) (US)
- Astellas Pharma (United States) (US)
- National Institutes of Health (US)
- Arlington, VA, USA
- Imperial College London (GB)
- Pfizer (United States) (US)
- Columbia University (US)
- SDG LLC, Cambridge, MA, USA
- Jazz Pharmaceuticals (United States) (US)
- Ceres (US)
- Chronic Pain Research Alliance, North Kingstown, RI, USA
- Zalicus, Cambridge, MA, USA
- University of Pittsburgh (US)
- Purdue Pharma (United States) (US)
- Technion – Israel Institute of Technology (IL)
- Corresponding author
- Edwards, Robert R.
- ORCID
- Edwards, Robert R.
- Dworkin, Robert H.
- Angst, Martin S.
- Freeman, Roy
- Hansson, Per
- Haroutounian, Simon
- Attal, Nadine
- Baron, Ralf
- Burke, Laurie B.
- Fillingim, Roger B.
- Gewandter, Jennifer S.
- Katz, Nathaniel P.
- Kopecky, Ernest A.
- Markman, John D.
- Nomikos, George
- Rice, Andrew S.C.
- Scholz, Joachim
- Simon, Lee S.
- Smith, Shannon M.
- Tobias, Jeffrey
- Tockarshewsky, Tina
- Wasan, Ajay D.
- Wen, Warren
- Yarnitsky, David
- Venue
- Pain
- Published
- 2016-05-05
- Volume
- 157
- Issue
- 9
- Pages
- 1851-1871
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- PMC
- PMC5965275
- OpenAlex
- W2359535866
- Cited by
- 403
- References
- 275
- Citations by year
- 2026: 29 · 2025: 51 · 2024: 45 · 2023: 47 · 2022: 35 · 2021: 64 · 2020: 44 · 2019: 32 · 2018: 26 · 2017: 24 · 2016: 3
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- U.S. Food and Drug Administration (U01-FD005936)
- National Institute on Aging (R01AG034982)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR064367)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- patient phenotyping, chronic pain, precision medicine, psychosocial factors, symptom characteristics, sleep patterns, endogenous pain modulation, clinical trial design
- MeSH terms
- Analgesics, Clinical Trials as Topic, Humans, Pain Measurement, Phenotype, Treatment Outcome, Chronic Pain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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