Everyone perceives pain differently. Whether they are experiencing pain from injury or illness, the level of pain a person experiences is unique to the person who is experiencing it. The level of pain can also be influenced by genetic, cultural, social, and psychological factors. This high level of variability makes measuring pain on a clinical scale challenging.
Because of this, clinical trials need to highlight both function and pain measurement. The ability to live a quality, meaningful life in which patients can carry out their daily activities is often more important than managing the pain itself, although the two can undoubtedly affect one another. In many clinical studies, pain reduction is a priority, although there is no objective pain measurement.
Why focus on the function?
By focusing on function, clinical trials can instead measure physical functioning based on patient-reported outcomes – how a patient perceives their pain levels – performance-based activities and other objective measures of activity. This can help researchers understand how effective treatments are in helping patients with acute or chronic pain get back to their daily lives, including at home, in their careers, and in the general activities that give them joy and purpose.
It is a much-needed discussion that the Inter-Agency Task Force on Pain Management Best Practices, a federal advisory board established by the Comprehension Addiction and Recovery Act of 2016, fueled last May. In it, they urged researchers, stakeholders, lawmakers, and other key audiences to place strong emphasis on function in developing effective pain management plans.
They found that taking a patient-centered approach to quality of life improved functionality and regaining daily living activities was essential for quality care for both acute and chronic pain. The task force suggested that this approach can also help strengthen patient-provider relationships, another crucial factor in health management.
However, the conversation is not over yet. More needs to be done as we continue to identify and implement best practices for researching and managing pain. Aside from shifting gears in clinical trials to look at function versus pain measurement, we need to better understand those who are at the center of the discussion: the patients themselves, who sometimes experience debilitating pain far beyond the physical Symptoms and their differences can go beyond our studies of pain.
Factors Affecting Pain Measurement
A person’s functional level can include work participation, social participation, and stress on caregivers. All of this needs to be taken into account when developing effective pain treatments. However, this is not always the case in clinical trials that focus less on mental and emotional well-being and more on the physical symptoms of the pain itself.
When a patient reports their level of pain, which is generally subjective, their concept of pain is likely to be influenced by a number of internal and external factors. For a person, the pain can be a level 10. For another person the pain can only be level three. The longer chronic pain occurs, the more the perception of pain can evolve over time. For example, a person who has had persistent pain for years might report more pain than someone who has had pain for several months due to its daily effects.
Examining pain through a biopsychosocial lens, which examines how biological, psychological, and social factors affect health, illness, and treatment, one can see the many elements that influence a patient’s personal understanding of pain. Biologically speaking, recent studies found that women (at the time of results) were more likely to report pain than men, and that women who were non-Hispanic-white and non-Hispanic-black women were also more likely to report pain that was “persistent and bothersome.” ”
Women are also at higher risk of common chronic pain conditions such as lower back pain, migraine headaches, fibromyalgia, and osteoarthritis. Other researchers have found that minority groups, especially older adults, tend to report a higher prevalence of pain.
Differences in pain assessment and treatment
Racial differences in pain assessment and management have long been a problem that can potentially be improved by shifting the focus from pain reduction to function recovery. Research has found that 47% of doctors are likely to underestimate the pain experienced by black patients, compared with 35% of doctors treating non-black patients. These differences can result in patients receiving the wrong course of treatment and therefore not relieving their pain.
Then there are social influences on the perception of pain. Experiments show that people can have a higher tolerance for pain when their boyfriend or romantic partner is present, but lower when they are alone. In addition, people who are under high stress may have lower pain thresholds. This is yet another reason why the medical community should collectively aim in clinical trials to prioritize function over pain measurement. Relying solely on patient perception may not give you accurate results, which can affect overall treatment development and research.
As we continue to shape the way we treat pain in clinical trials, it’s important to consider the differences among study participants. Developing effective treatment plans that work on a larger scale ultimately depends on diversity, measurement of function, and how well those treatments help patients get back to their daily routine.
Successful treatment not only relieves pain, but also enables people to be fully involved in their work, social life, and other activities that give their life meaning.