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Tonya M Palermo,1 Karen Deborah Davis,2 Didier Bouhassira,3 Robert W Hurley,4 Joel D Katz,5 Francis J Keefe,6 Michael E Schatman,7,8 Dennis C Turk,1 David Yarnitsky9 1Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA; 2Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network; University of Toronto, Toronto, Ontario, Canada; 3Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France; 4Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; 5Department of Psychology, York University, Toronto, Ontario, Canada; 6Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA; 7Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA; 8Department of Population Health − Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA; 9Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, IsraelThis article is being published concurrently in Journal of Pain, PAIN, European Journal of Pain, Pain Medicine, Canadian Journal of Pain, Journal of Pain Research, Clinical Journal of Pain, and PAIN Reports. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Citation from any of the journals can be used when citing this article.Correspondence: Tonya M Palermo, PhD, Department of Anesthesiology & Pain Medicine, University of Washington, P.O. Box 5371, M/S BC-3, Seattle Children’s Research Institute, Seattle, WA 98145-5005, USA, E-mail address: tonya.palermo@seattlechildrens.org

A number of pharmacologic treatments examined in recent randomized clinical trials (RCTs) have failed to show statistically significant superiority to placebo in conditions in which their efficacy had previously been demonstrated. Assuming the validity of previous evidence of efficacy and the comparability of the patients and outcome measures in these studies, such results may be a consequence of limitations in the ability of these RCTs to demonstrate the benefits of efficacious analgesic treatments vs placebo ("assay sensitivity"). Efforts to improve the assay sensitivity of analgesic trials could reduce the rate of falsely negative trials of efficacious medications and improve the efficiency of analgesic drug development. Therefore, an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials consensus meeting was convened in which the assay sensitivity of chronic pain trials was reviewed and discussed. On the basis of this meeting and subsequent discussions, the authors recommend consideration of a number of patient, study design, study site, and outcome measurement factors that have the potential to affect the assay sensitivity of RCTs of chronic pain treatments. Increased attention to and research on methodological aspects of clinical trials and their relationships with assay sensitivity have the potential to provide the foundation for an evidence-based approach to the design of analgesic clinical trials and expedite the identification of analgesic treatments with improved efficacy and safety. [ABSTRACT FROM AUTHOR]

We compared the methodology and the recommendations of evidence-based guidelines for the management of fibromyalgia syndrome (FMS) to give an orientation within the continuously growing number of reviews on the therapy of FMS. Systematic searches up to April 2008 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, the Association of the Scientific Medical Societies in Germany (AWMF) and Medline were conducted. Three evidence-based guidelines for the management of FMS published by professional organizations were identified: The American Pain Society (APS) (2005), the European League Against Rheumatism (EULAR) (2007), and the AWMF (2008). The steering committees and panels of APS and AWMF were comprised of multiple disciplines engaged in the management of FMS and included patients, whereas the task force of EULAR only consisted of physicians, predominantly rheumatologists. APS and AWMF ascribed the highest level of evidence to systematic reviews and meta-analyses, whereas EULAR credited the highest level of evidence to randomised controlled studies. Both APS and AWMF assigned the highest level of recommendation to aerobic exercise, cognitive-behavioral therapy, amitriptyline, and multicomponent treatment. In contrast, EULAR assigned the highest level of recommendation to a set of to pharmacological treatment. Although there was some consistency in the recommendations regarding pharmacological treatments among the three guidelines, the APS and AWMF guidelines assigned higher ratings to CBT and multicomponent treatments. The inconsistencies across guidelines are likely attributable to the criteria used for study inclusion, weighting systems, and composition of the panels. [ABSTRACT FROM AUTHOR]

An essential component of the interpretation of results of randomized clinical trials of treatments for chronic pain involves the determination of their clinical importance or meaningfulness. This involves two distinct processes--interpreting the clinical importance of individual patient improvements and the clinical importance of group differences--which are frequently misunderstood. In this article, we first describe the essential differences between the interpretation of the clinical importance of patient improvements and of group differences. We then discuss the factors to consider when evaluating the clinical importance of group differences, which include the results of responder analyses of the primary outcome measure, the treatment effect size compared to available therapies, analyses of secondary efficacy endpoints, the safety and tolerability of treatment, the rapidity of onset and durability of the treatment benefit, convenience, cost, limitations of existing treatments, and other factors. The clinical importance of individual patient improvements can be determined by assessing what patients themselves consider meaningful improvement using well-described methods. In contrast, the clinical meaningfulness of group differences must be determined by a multi-factorial evaluation of the benefits and risks of the treatment and of other available treatments for the condition in light of the primary goals of therapy. Such determinations must be conducted on a case-by-case basis, and are ideally informed by patients and their significant others, clinicians, researchers, statisticians, and representatives of society at large. [ABSTRACT FROM AUTHOR]

STUDY DESIGN.: Spine update on some major misconceptions of the biopsychosocial model. OBJECTIVE.: To refute some of the erroneous beliefs about the weaknesses of the application of the biopsychosocial model to spine care. SUMMARY AND BACKGROUND DATA.: Currently, the biopsychosocial model of illness is the most heuristic perspective in understanding the etiology, assessment, treatment, and prevention of pain-related disorders such as spinal pain and disability. Only the misuse of the biopsychosocial model by inappropriately trained health care specialists decreases its maximum utility and validity. METHODS.: This is a point-by-point response to a previous article in Spine, which inaccurately discussed some assumed limitations of the biopsychosocial model as related to spine care. It is also a more comprehensive review of the model and related clinical applications. Articles from the scientific literature are cited in refuting those assumed limitations. RESULTS.: The previous article in Spine provided a superficial, and often erroneous, review of the biopsychosocial model of illness. In providing a point-by-point refutation of that review, a number of important clarifications were delineated. For example, concerns raised about the sole reliance of self-report outcomes are shown to be unfounded. By definition, the 'bio' 'psycho' 'social' underscores the important interactive contribution of factors in each of these defining domains, and requires their individual assessments. It was also erroneously stated that there was an inherent 'disconnect' between physical pathology and self-report in this model. However, the richness of the biopsychosocial model is the recognition of the need to continue to understand the pathoanatomic and pathophysiological explanations of spinal disorders (the bio part of the equation), as well as the psychosocial factors that may also be important (the psychosocial part of biopsychosocial). Other questions raised about the scientific status of the model, the effectiveness of treatments based on the model, and so forth, were also addressed. CONCLUSION.: In agreement with the earlier Spine update, the '...biopsychosocial model has been readily adapted to all aspects of spine care with many positive implications.' However, the author then raised some apparently major concerns. These concerns were shown to be unfounded. In point-of-fact, there is an ever-growing scientific literature demonstrating the heuristic value of this model in developing more effective assessment and treatment methods for spinal disorders, as well as guiding greater 'cutting-edge' research on their etiologies and potential prevention techniques. [ABSTRACT FROM AUTHOR]

Objectives: To describe the plight of the person with fibromyalgia syndrome [FMS], the psychosocial and behavioral factors that contribute to the extent of suffering experienced, and the heterogeneity of patient subgroups that characterize adaptation and response to treatment.Findings: People diagnosed with FMS are confronted with a range of factors the influence there perception, adaptation, and response to treatment. Three subgroups of FMS patients have been identified using cluster analytic procedures. One subgroup is characterized by high levels of pain, perceived interference of symptoms with life, affective distress and social support, and low levels of perceived control and activity-'Dysfunctional.' The unique characteristics of a second subgroup, relative to other FMS patients, relates to their perceptions of little support from significant others and a high degree of negative responses to their reports of symptoms-'Interpersonally Distressed.' Compared to the other two groups, the third group reported lower levels of pain, emotional distress, nd higher levels of perceived control over symptoms, and were more active-'Adaptive Copers.' The percentage of patients classified within each of the three groups were roughly equivalent. The three subgroups respond differentially to a standard interdisciplinary rehabilitation program.Conclusions: Successful treatment of patients diagnosed with FMS will require attention to important individual differences inpatients' perceptions, modes of responding, and responses by significant others in addition to physical factors associated with FMS. [ABSTRACT FROM AUTHOR]

Poor adherence to treatment and life-style recommendations is ubiquitous. Ultimately, the patient is responsible -- but what more could you be doing? Try these helpful approaches. [ABSTRACT FROM AUTHOR]

Chronic neuropathic pain is a prevalent problem that eludes cure and adequate treatment. The persistence of intense and aversive symptoms, inadequacy of available treatments, and impact of such pain on all aspects of functioning underscore the important role of several psychosocial factors in causing, maintaining, and amplifying the perception of pain severity, coping adequacy, adaptation, impaired physical function, and emotional distress responses. Moreover, these factors have an influential role in response to treatment recommendations. In this article, we (1) review the prevalence and nature of emotional distress, (2) describe and propose methods for screening and comprehensive psychosocial assessment, and (3) review evidence supporting the potential complementary role of psychosocial treatments of patients with chronic pain. The cognitive-behavioral perspective and treatment approach are emphasized because the greatest amount of evidence supports their benefits. Published results of psychological treatments are modest; however, the same indictment can be placed on currently available pharmacological, medical, and interventional treatments for patients with chronic pain. We note the limited research on the effectiveness of psychological treatment specifically applied to patients with chronic neuropathic pain but suggest that it is reasonable to extrapolate from successful trials in other types of chronic pain. Furthermore, psychological approaches should not be viewed as alternatives but rather should be integrated as part of a comprehensive approach to the treatment of patients with chronic neuropathic pain. [ABSTRACT FROM AUTHOR]

Abstract: Pragmatic, randomized, controlled trials hold the potential to directly inform clinical decision making and health policy regarding the treatment of people experiencing pain. Pragmatic trials are designed to replicate or are embedded within routine clinical care and are increasingly valued to bridge the gap between trial research and clinical practice, especially in multidimensional conditions, such as pain and in nonpharmacological intervention research. To maximize the potential of pragmatic trials in pain research, the careful consideration of each methodological decision is required. Trials aligned with routine practice pose several challenges, such as determining and enrolling appropriate study participants, deciding on the appropriate level of flexibility in treatment delivery, integrating information on concomitant treatments and adherence, and choosing comparator conditions and outcome measures. Ensuring data quality in real-world clinical settings is another challenging goal. Furthermore, current trials in the field would benefit from analysis methods that allow for a differentiated understanding of effects across patient subgroups and improved reporting of methods and context, which is required to assess the generalizability of findings. At the same time, a range of novel methodological approaches provide opportunities for enhanced efficiency and relevance of pragmatic trials to stakeholders and clinical decision making. In this study, best-practice considerations for these and other concerns in pragmatic trials of pain treatments are offered and a number of promising solutions discussed. The basis of these recommendations was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.)

Abstract: Establishing clinically meaningful changes in pain experiences remains important for clinical trials of chronic pain treatments. Regulatory guidance and pain measurement initiatives have recommended including patient-reported global assessment measures (eg, Patient-Global Impression of Change [PGIC]) to aid interpretation of within-patient differences in domain-specific clinical trial outcomes (eg, pain intensity). The objectives of this systematic review were to determine the frequency of global assessment measures inclusion, types of measures, domains assessed, number and types of response options, and how measures were analyzed. Of 4172 abstracts screened across 6 pain specialty journals, we reviewed 96 clinical trials of chronic pain treatments. Fifty-two (54.2%) studies included a global assessment measure. The PGIC was most common (n = 28; 53.8%), with relatively infrequent use of other measures. The majority of studies that used a global assessment measure (n = 31; 59.6%) assessed change or improvement in an unspecified domain. Others assessed overall condition severity (n = 9; 17.3%), satisfaction (n = 8; 15.4%), or overall health status/recovery (n = 5; 9.6%). The number, range, and type of response options were variable and frequently not reported. Response options and reference periods even differed within the PGIC. Global assessment measures were most commonly analyzed as continuous variables (n = 24; 46.2%) or as dichotomous variables with positive categories combined to calculate the proportion of participants with a positive response to treatment (n = 18; 34.6%). This review highlights the substantial work necessary to clarify measurement and use of patient global assessment in chronic pain trials and provides short- and long-term considerations for measure selection, reporting and analysis, and measure development., (Copyright © 2024 International Association for the Study of Pain.)

Background: Randomized clinical trials (RCTs) generally assess efficacy and safety separately, with the conclusion of whether a treatment is beneficial based solely on the efficacy endpoint. However, assessing and combining efficacy and safety domains, using a single composite outcome measure, can provide a more comprehensive assessment of the overall effect of a treatment. Furthermore, composite outcomes can incorporate information regarding the relationship between the individual outcomes. In fact, such outcomes have been suggested in the clinical trials literature for at least 15 years., Objectives: To (1) identify whether recent primary publications of chronic pain RCTs from major pain journals included a composite outcome measure of benefits and harms and (2) discuss the potential benefits of such outcomes in various stages of treatment development, including as outcome measures in RCTs, and to support decisions of Data and Safety Monitoring Boards and ordering of treatments in the context of treatment guidelines., Evidence Review: RCTs published in 6 major pain journals published between 2016 and 2021 that investigated interventions for chronic pain were reviewed., Findings: Of 73 RCTs identified, only 2 included a composite outcome measure of benefits and harms. Both of these articles compared 2 active treatments., Conclusions: Composite outcomes of benefits and harms are underutilized in chronic pain RCTs. The advantages and challenges of using such outcomes are discussed., Competing Interests: Competing interests: RHD has received in the past 5 years research grants and contracts from the US Food and Drug Administration and the US National Institutes of Health, and compensation for serving on advisory boards or consulting on clinical trial methods from Abide, Acadia, Adynxx, Analgesic Solutions, Aptinyx, Aquinox, Asahi Kasei, Astellas, Beckley, Biogen, Biohaven, Biosplice, Boston Scientific, Braeburn, Cardialen, Centrexion, Chiesi, Chromocell, Clexio, Collegium, CoimbiGene, Confo, Decibel, Editas, Eli Lilly, Endo, Ethismos (equity), Eupraxia, Exicure, GlaxoSmithKline, Glenmark, Gloriana, Hope, Kriya, Lotus, Mainstay, Merck, Mind Medicine (also equity), Neumentum, Neurana, NeuroBo, Novaremed, Novartis, OliPass, Orion, Oxford Cannabinoid Technologies, Pfizer, Q-State, Reckitt Benckiser, Regenacy (also equity), Rho, Sangamo, Sanifit, Scilex, Semnur, SIMR Biotech, Sinfonia, SK Biopharmaceuticals, Sollis, SPM Therapeutics SPRIM, Teva, Theranexus, Vertex, Vizuri, and WCG. JG, in the past 36 months, has received (unrelated to this work) grant support from the NIH and Neurometrix, consulting income from AlgoTX, GW pharmaceuticals, Eikonozo, and Saluda, and shares for consulting from Eisana Corp. DL, in the past 36 months, has received (unrelated to this work) support from the NIH and the US Food & Drug Administration. DT, in the last 36 months, have received (unrelated to this work) grant support from NIH and NIOSH, consulting fees from Eli Lilly, Pfizer, GSK/Novartis, and Omnicom Health Group, and is Editor-in-Chief of the Clinical Journal of Pain., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Abstract: In the traditional clinical research model, patients are typically involved only as participants. However, there has been a shift in recent years highlighting the value and contributions that patients bring as members of the research team, across the clinical research lifecycle. It is becoming increasingly evident that to develop research that is both meaningful to people who have the targeted condition and is feasible, there are important benefits of involving patients in the planning, conduct, and dissemination of research from its earliest stages. In fact, research funders and regulatory agencies are now explicitly encouraging, and sometimes requiring, that patients are engaged as partners in research. Although this approach has become commonplace in some fields of clinical research, it remains the exception in clinical pain research. As such, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials convened a meeting with patient partners and international representatives from academia, patient advocacy groups, government regulatory agencies, research funding organizations, academic journals, and the biopharmaceutical industry to develop consensus recommendations for advancing patient engagement in all stages of clinical pain research in an effective and purposeful manner. This article summarizes the results of this meeting and offers considerations for meaningful and authentic engagement of patient partners in clinical pain research, including recommendations for representation, timing, continuous engagement, measurement, reporting, and research dissemination., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.)

Background: Pain is the leading cause of disability worldwide among adults and effective treatment options remain elusive. Data harmonization efforts, such as through core outcome sets (COS), could improve care by highlighting cross-cutting pain mechanisms and treatments. Existing pain-related COS often focus on specific conditions, which can hamper data harmonization across various pain states., Methods: Our objective was to develop four overarching COS of domains/subdomains (i.e., what to measure) that transcend pain conditions within different pain categories. We hosted a meeting to assess the need for these four COS in pain research and clinical practice. Potential COS domains/subdomains were identified via a systematic literature review (SLR), meeting attendees, and Delphi participants. We conducted an online, three step Delphi process to reach a consensus on domains to be included in the four final COS. Survey respondents were identified from the SLR and pain-related social networks, including multidisciplinary health care professionals, researchers, and people with lived experience (PWLE) of pain. Advisory boards consisting of COS experts and PWLE provided advice throughout the process., Findings: Domains in final COS were generally related to aspects of pain, quality of life, and physical function/activity limitations, with some differences among pain categories. This effort was the first to generate four separate, overarching COS to encourage international data harmonization within and across different pain categories., Interpretation: The adoption of the COS in research and clinical practice will facilitate comparisons and data integration around the world and across pain studies to optimize resources, expedite therapeutic discovery, and improve pain care., Funding: Innovative Medicines Initiative 2 Join Undertaking; European Union Horizon 2020 research innovation program, European Federation of Pharmaceutical Industries and Associations (EFPIA) provided funding for IMI-PainCare. RDT acknowledges grants from Esteve and TEVA., Competing Interests: Giulia Bova has nothing to disclose. Anthony Domenichiello has nothing to disclose. Janelle Letzen has nothing to disclose. Daniela C. Rosenberger has nothing to disclose. Andrew Siddons has nothing to disclose. Ulrike Kaiser is the principal investigator of VAPAIN. Adam Anicich has nothing to disclose. Ralf Baron reports grants from EU Projects: „Europain“ (115,007). DOLORisk (633,491). IMI Paincare (777,500). Ðerman Federal Ministry of Education and Research (BMBF): Verbundprojekt: Frühdetektion von Schmerzchronifizierung (NoChro) (13GW0338C). Ðerman Research Network on Neuropathic Pain (01EM0903). Ðfizer Pharma GmbH, Sanofi Genzyme GmbH, Grünenthal GmbH, Mundipharma Research GmbH und Co. KG., Alnylam Pharmaceuticals Inc., Zambon GmbH, Bayer AG, Sanofi Aventis GmbHÐ personal fees from Pfizer Pharma GmbH, Sanofi Genzyme GmbH, Grünenthal GmbH, Mundipharma, Lilly GmbH, Desitin Arzneimittel GmbH, Teva GmbH, Bayer AG, MSD GmbH, Seqirus Australia Pty. Ltd, Novartis Pharma GmbH, TAD Pharma GmbH, Grünenthal SA Portugal, Grünen¬thal Pharma AG Schweiz, Grünenthal B.V. Niederlande, Evapharma, Takeda Pharmaceuticals International AG Schweiz, Ology Medical Education Netherlands, Ever Pharma GmbH, Amicus Therapeutics GmbH, Novo Nordisk Pharma GmbH, Chiesi GmbH, Stada Mena DWC LLC Dubai, Hexal AG, Viatris, personal fees from Pfizer Pharma GmbH, Sanofi Genzyme GmbH, Grünenthal GmbH, Lilly, Novartis Pharma GmbH, Bristol-Myers Squibb, Biogenidec, AstraZeneca GmbH, Daiichi Sankyo, Glenmark Pharmaceuticals S.A., Seqirus Australia Pty. Ltd, Teva Pharmaceuticals Europe Niederlande, Teva GmbH, Genentech, Mundipharma International Ltd. UK, Galapagos NV, Kyowa Kirin GmbH, Vertex Pharmaceuticals Inc., Biotest AG, Celgene GmbH, Desitin Arzneimittel GmbH, Regeneron Pharmaceuticals Inc. USA, Theranexus DSV CEA Frankreich, Abbott Products Operations AG Schweiz, Bayer AG, Grünenthal Pharma AG Schweiz, Akcea Therapeutics Germany GmbH, Asahi Kasei Pharma Corporation, AbbVie Deutschland GmbH & Co. KG, Air Liquide Sante International Frankreich, Alnylam Germany GmbH, Lateral Pharma Pty Ltd, Hexal AG, Angelini, Janssen, SIMR Biotech Pty Ltd Australien, Confo Therapeutics N. V. Belgium, Merz Pharmaceuticals GmbH, Neumentum Inc., F. Hoffmann-La Roche Ltd. Switzerland, AlgoTherapeutix SAS France, Nanobiotix SA France, AmacaThera Inc. Canada, outside the submitted work. Judy Birch has nothing to disclose. Didier Bouhassira reports personal fees from Grunenthal, personal fees from Bayer, outside the submitted work. George Casey has nothing to disclose. Katie Golden has nothing to disclose. Smriti Iyengar has nothing to disclose. Barbara Karp has nothing to disclose. Hiltrud Liedgens has nothing to disclose. Winfried Meissner reports grants from European Commission, during the conduct of the study; personal fees from Grünenthal, grants from Mundipharma, grants from Pfizer, personal fees from Ethypharm, personal fees from Kyowa, personal fees from Spectrum Therapeutics, outside the submitted work. Kate Nicholson has no conflicts or disclosures. She is employed by the National Pain Advocacy Center, which takes no industry funding and advocates for the health and rights of people living with pain. She was a member on the patient Advisory Committee for this project and received an honorarium for attending early organizational strategic planning for the project. She also received support for attending the European Pain Federation (EFIC) conference to present on concepts from this project. Leah Pogorzala has nothing to disclose. Deidre Ryan has nothing to disclose. Rolf-Detlef Treede reports grants from Innovative Medicines Initiative EU and EFPIA, during the conduct of the study; grants from Deutsche Forschungsgemeinschaft, grants from Esteve, TEVA, personal fees from Bayer, Grünenthal, GSK, Merz, Saluda Medical, Sanofi, Cered, and Vertex outside the submitted work. Peter Tugwell has nothing to disclose. Dennis Turk has received in the past 5 years research grants and contracts from the US Food and Drug Administration and the US National Institutes of Health, U.S. Patient-Centered Outcome Research Institute, and US National Center for Occupational Health and Safety; received compensation for serving on advisory boards from Eli Lilly, GlaxoSmithKline, Novartis, and Pfizer. He received an honorarium from Wolters Kluwer in his role as editor-in-chief of The Clinical Journal of Pain. Katy Vincent reports grants from Innovative Medicines Initiative 2 Joint Undertaking (GA No. 777500) (Horizon 2020 and EFPIA), during the conduct of the study; grants and personal fees from Bayer Healthcare (paid to institution), and personal fees from Reckitts (paid to institution), outside the submitted work. She received payment from Gedeon Richter for consultancy and talks, paid to the institution. Jan Vollert reports personal fees from Vertex Pharmaceuticals, personal fees from Embody Orthopaedics, personal fees from Casquar, outside the submitted work. Paula Williamson chairs the COMET Initiative Management Group. Sarah Woller has nothing to disclose. Ruth Zaslansky has nothing to disclose. Laura Wandner has nothing to disclose. Esther Pogatzki-Zahn reports grants from the German Research Foundation (DFG), the Federal Ministry of Education and Research (BMBF), the Federal Joint Committee (G-BA) and the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777500. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA. All money goes to the institutions (WWU/UKM) EPZ is working for. EPZ received personal fees (money went to her institution) from Gruenenthal, Medtronic and Novartis unrelated to the current work. She received an honorarium in her role as debuty-editor-in-chief of the European Journal of Anaesthesiology., (© 2023 Published by Elsevier Ltd.)

Abstract: The decades since the inauguration of the International Association for the Study of Pain have witnessed major advances in scientific concepts (such as the biopsychosocial model and chronic primary pain as a disease in its own right) and in new technologies and approaches (from molecular biology to brain imaging) that have inspired innovations in pain research. These have guided progress in pain management and education about pain for healthcare professionals, the general public, and administrative agencies., (Copyright © 2023 International Association for the Study of Pain.)