Starts:

Tuesday, September 20th
10:45am-12:15pm EDT

Category:

Topical Workshop

Tracks:

Novel Experimental/Analytic Approaches/Tools

Room

715 A/B

Moving Beyond The Means and Standard Deviations in Pain Research – Insights to Enhance Personalized Pain Care

Thinking about pain after surgery in terms of predictors for those with complex pain at a fixed postoperative time (e.g., 3 months, 1 year) limits our ability to understand the process of recovery and test interventions. While research and treatments during the COVID-19 pandemic initially focused on a dichotomous outcome (mortality), they rapidly evolved to examining acute symptoms, hospitalization, respiratory support, and long term sequelae from infection. These studies are informing treatment and guiding individual care. The three members of this panel will briefly describe how they use person-centered analytic approaches to identify high risk individuals and guide personalized approaches for pain and symptom management; early intervention in people with a slower recovery; and apply individual recovery trajectory as the primary outcome measure for interventions to speed recovery. The goal is to spur conversation with the audience on how these approaches can be practically applied to advance research, prevention, and treatment of chronic pain. It begins by replacing the phrase, “chronic pain after surgery”, a problem in few individuals, “speeding recovery from pain after surgery” in all patients.

Presentations

Time
10:45am EDT12:15pm EDT

Moving Towards Person-centered Analytic Approaches in Cancer Pain and Symptom Research and Care

Tracks: Novel Experimental/Analytic Approaches/Tools
Categories: Topical Workshop

Until recently, the majority of descriptive and intervention studies have reported on various pain characteristics (e.g., pain intensity, pain qualities) outcomes (efficacy of an analgesic regimen) using variable centered analytic approaches (e.g., means, medians, standard deviations, univariable or multivariable regression analysis). While the use of these approaches provides valuable information, they do not provide insights into the large amount of inter-individual variability that exists in patients’ pain experiences and responses to interventions. This presentation will provide an overview of the benefits and challenges of using person-centered analytic approaches (e.g., growth mixture modeling, latent variable modeling) to identify subgroups of patients with distinct pain profiles. Examples of how these approaches are being used to analyzed data related to cancer pain, chemotherapy-induced peripheral neuropathy, and pain and depression will be reviewed.

10:45am EDT12:15pm EDT

Using Person-centered Analytic Approaches as Primary Outcomes in Postoperative Pain and Recovery Research

Tracks: Novel Experimental/Analytic Approaches/Tools
Categories: Topical Workshop
Presented By: James C. Eisenach

Recovery from pain after surgery is usually studied in a cross-sectional manner. This lecture discusses how this method provides information only on the small number of individuals with continuing pain and fails to quantify the burden of pain over time since surgery in everyone. It describes how more frequent assessments of pain after surgery can be acquired and analyzed using growth curve models appropriate for person-centered forecasting and latent class analysis. The increased precision and statistical power of this approach compared to classic repeated measure ANOVA methods when examining interventions to speed recovery after surgery will also be discussed. Data from two recent interventional clinical trials which used daily assessments for 2 months after surgery to define person-centered modeled trajectory as the primary outcome measure will be contrasted with the traditional dichotomous, cross sectional outcome. Finally, challenges to gathering daily data in this research context and approaches to overcome those challenges will be presented.

10:45am EDT12:15pm EDT

Using Trajectories of Acute Pain After Surgery to Guide Interventions in a Transitional Pain Service

Tracks: Novel Experimental/Analytic Approaches/Tools
Categories: Topical Workshop
Presented By: Dr. Hance Clarke

The Canadian Pain Task Force (CPTF) established the prevention and management of chronic pain as a top priority for Canadians. The Transitional Pain Service (TPS) at the Toronto General Hospital was highlighted as an innovation in pain care. The service has developed over time to secure sustainable multidisciplinary interventions for the prevention and management of chronic postsurgical pain (CPSP) and persistent opioid use following surgeryA review of the known risk factors associated with the development CPSP across the life span will be discussed. Moving beyond risk factors, publications have outlined acute pain trajectories that suggest patterns of pain with a link to the development of CPSP.  Within the TPS, pain intensity and opioid use in the days following surgery can guide interventions and signal patients that need increased resources upon presentation to the clinic.  

Presenters

Dr. Hance Clarke

Director of Pain Services
University Health Network

James C. Eisenach

FM James, III Professor
Wake Forest School of Medicine

Dr. Christine Miaskowski

Professor
University of California