Expect analgesic failure; pursue analgesic success
Open accessAbstract
Most analgesic drugs work well but in only a small percentage of people. Andrew Moore and colleagues argue that we need to move away from a focus on average response and seek out what works for each patient
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Chronic pain is a treatment-resistant condition.
“Chronic pain is a treatment-resistant condition (Moore 2013).”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2020) · cites this paper as Moore 2013
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Cites
Pain measures and cut-offs - 'no worse than mild pain' as a simple, universal outcome
Moore, R. A., Straube, S., & Aldington, D. (2013) · Anaesthesia · doi:10.1111/anae.12148 · Cited by 362 · see citing works
Moore, R. A., Moore, O. A., Derry, S., Peloso, P. M., Gammaitoni, A. R., & Wang, H. (2010) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2009.107805 · Cited by 279 · see citing works
Self-citationMoore, R. A., Derry, S., McQuay, H. J., Straube, S., Aldington, D., Wiffen, P., Bell, R. F., Kalso, E., & Rowbotham, M. C. (2010) · Pain · doi:10.1016/j.pain.2009.08.007 · Cited by 98 · see citing works
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Research works printed but not linked: 18
- Smith R. The drugs don't work. BMJ 2003;327:0.9.
- Moore RA, Straube S, Paine J, Derry S, McQuay HJ. Minimum efficacy criteria for comparisons between treatments using individual patient meta-analysis of acute pain trials: examples of etoricoxib, paracetamol, ibuprofen, and ibuprofen/paracetamol combinations after third molar extraction. Pain 2011;152:982-9.
- Moore RA, Smugar SS, Wang H, Peloso PM, Gammaitoni A. Numbers-needed-to-treat analyses-do timing, dropouts, and outcome matter? Pooled analysis of two randomized, placebo-controlled chronic low back pain trials. Pain 2010;151:592-7.
- Arnold LM, Wang F, Ahl J, Gaynor PJ, Wohlreich MM. Improvement in multiple dimensions of fatigue in patients with fibromyalgia treated with duloxetine: secondary analysis of a randomized, placebo-controlled trial. Arthritis Res Ther 2011;13:R86.
- Hoffman DL, Sadosky A, Dukes EM, Alvir J. How do changes in pain severity levels correspond to changes in health status and function in patients with painful diabetic peripheral neuropathy? Pain 2010;149:194-201.
- Moore RA, Straube S, Paine J, Phillips CJ, Derry S, McQuay HJ. Fibromyalgia: Moderate and substantial pain intensity reduction predicts improvement in other outcomes and substantial quality of life gain. Pain 2010;149:360-4.
- Straube S, Moore RA, Paine J, Derry S, Phillips CJ, Hallier E, et al. Interference with work in fibromyalgia: effect of treatment with pregabalin and relation to pain response. BMC Musculoskelet Disord 2011;12:125.
- Moore RA, Straube S, Eccleston C, Derry S, Aldington D, Wiffen P, et al. Estimate at your peril: imputation methods for patient withdrawal can bias efficacy outcomes in chronic pain trials using responder analyses. Pain 2012;153:265-8.
- Moore RA, Eccleston C, Derry S, Wiffen P, Bell RF, Straube S, et al. "Evidence" in chronic pain-establishing best practice in the reporting of systematic reviews. Pain 2010;150:386-9.
- Moore RA, Gavaghan D, Tramèr MR, Collins SL, McQuay HJ. Size is everything-large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain 1998;78:209-16.
- Stacey BR, Barrett JA, Whalen E, Phillips KF, Rowbotham MC. Pregabalin for postherpetic neuralgia: placebo-controlled trial of fixed and flexible dosing regimens on allodynia and time to onset of pain relief. J Pain 2008;9:1006-17.
- Wang F, Ruberg SJ, Gaynor PJ, Heinloth AN, Arnold LM. Early improvement in pain predicts pain response at endpoint in patients with fibromyalgia. J Pain 2011;12:1088-94.
- Crofford LJ, Mease PJ, Simpson SL, Young JP Jr, Martin SA, Haig GM, et al. Fibromyalgia relapse evaluation and efficacy for durability of meaningful relief (FREEDOM): a 6-month, double-blind, placebo-controlled trial with pregabalin. Pain 2008;136:419-31.
- Lin HY, Cheng TT, Wang JH, Lee CS, Chen MH, Lei V, et al. Etoricoxib improves pain, function and quality of life: results of a real-world effectiveness trial. Int J Rheum Dis 2010;13:144-50.
- Watson CP, Vernich L, Chipman M, Reed K. Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial. Neurology 1998;51:1166-71.
- Kroenke K, West SL, Swindle R, Gilsenan A, Eckert GJ, Dolor R, et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA 2001;286,2947-55.
- Simon G. Choosing a first line antidepressant. Equal on average does not mean equal for everyone. JAMA 2001;286:3003-4.
- McQuay HJ, Derry S, Moore RA, Poulain P, Legout V. Enriched enrolment with randomised withdrawal (EERW): time for a new look at clinical trial design in chronic pain. Pain 2008;135:217-20.
Cited by
Sorted by citations
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Eccleston, C., & Morley, S. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub3 · Cited by 1,634 · see citing works
Self-citationKrebs, E. E., Gravely, A., Nugent, S., Jensen, A. C., DeRonne, B., Goldsmith, E. S., Kroenke, K., Bair, M. J., & Noorbaloochi, S. (2018) · JAMA · doi:10.1001/jama.2018.0899 · Cited by 983 · see citing works
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Fisher, E., Hearn, L., & Eccleston, C. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub4 · Cited by 605 · see citing works
Self-citationWhen pain gets stuck: the evolution of pain chronification and treatment resistance
Borsook, D., Youssef, A. M., Simons, L., Elman, I., & Eccleston, C. (2018) · Pain · doi:10.1097/j.pain.0000000000001401 · Cited by 281 · see citing works
Smart, K. M., Wand, B. M., & O'Connell, N. E. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010853.pub2 · Cited by 196 · see citing works
Non-prescription (OTC) oral analgesics for acute pain - an overview of Cochrane reviews
Moore, R. A., Wiffen, P. J., Derry, S., Maguire, T., Roy, Y. M., & Tyrrell, L. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010794.pub2 · Cited by 174 · see citing works
Self-citationPsychological therapies for the management of chronic neuropathic pain in adults
Eccleston, C., Hearn, L., & Williams, A. C. D. C. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011259 · Cited by 138 · see citing works
Self-citationPsychological therapies for the management of chronic neuropathic pain in adults
Eccleston, C., Hearn, L., & Williams, A. C. D. C. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011259.pub2 · Cited by 102 · see citing works
Self-citationAdvancing psychological therapies for chronic pain
Eccleston, C., & Crombez, G. (2017) · F1000Research · doi:10.12688/f1000research.10612.1 · Cited by 67 · see citing works
Self-citationKallupi, M., Carrette, L. L. G., Kononoff, J., Solberg Woods, L. C., Palmer, A. A., Schweitzer, P., George, O., & de Guglielmo, G. (2020) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1915143117 · Cited by 64 · see citing works
Taylor, S. J. C., Carnes, D., Homer, K., Kahan, B. C., Hounsome, N., Eldridge, S., Spencer, A., Pincus, T., Rahman, A., & Underwood, M. (2016) · PLoS Medicine · doi:10.1371/journal.pmed.1002040 · Cited by 63 · see citing works
“Although pharmacological therapies have an important role in chronic pain, their effectiveness is often limited [5], and there is considerable concern about the adverse effects of nonsteroidal anti-inflammatory drugs [6,7].”
Investigating the veracity of a sample of divergent published trial data in spinal pain
O'Connell, N. E., Moore, R. A., Stewart, G., Fisher, E., Hearn, L., Eccleston, C., & Williams, A. C. D. C. (2023) · Pain · doi:10.1097/j.pain.0000000000002659 · Cited by 36 · see citing works
Self-citationManaging chronic pain in the non-specialist setting: a new SIGN guideline
Smith, B. H., Hardman, J. D., Stein, A., & Colvin, L. (2014) · British Journal of General Practice · doi:10.3399/bjgp14x680737 · Cited by 16 · see citing works
Korownyk, C. S., Montgomery, L., Young, J., Moore, S., Singer, A. G., MacDougall, P., Darling, S., Ellis, K., Myers, J., Rochford, C., et al. (2022) · Canadian Family Physician · doi:10.46747/cfp.6803e63 · Cited by 2 · see citing works
- Authors
- Moore, A., Derry, S., Eccleston, C., & Kalso, E.
- Affiliations
- Churchill Hospital (GB)
- University of Bath (GB)
- Helsinki University Hospital (FI)
- Corresponding author
- Moore, A.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2013-05-03
- Volume
- 346
- Issue
- may03 1
- Pages
- f2690-f2690
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W2105525460
- Cited by
- 271
- References
- 3
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 9 · 2023: 6 · 2022: 16 · 2021: 16 · 2020: 12 · 2019: 17 · 2018: 20 · 2017: 42 · 2016: 34 · 2015: 37 · 2014: 35 · 2013: 13 · 2012: 2
- FWCI
- 50.69
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- Työväentutkimus Vuosikirja (submittedVersion, other-oa)
- The University of Bath Online Publications Store (The University of Bath) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Pure (University of Bath) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- analgesic failure, personalized pain management, patient response variability, analgesic efficacy, personalized medicine, pain management
- MeSH terms
- Analgesics, Humans, Research Design, Treatment Failure, Chronic Pain, Pain Management
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