Towards a tool to discriminate between pain mechanistic descriptors: expert ranking of clinical features and allocation of weights using a forced choice paradigmNatl Ctr Complementary & Integrat Hlth, Div Intramural Res, NIH, Bethesda, MD USA..
Univ Hosp Schleswig Holstein, Dept Neurol, Div Neurol Pain Res & Therapy, Campus Kiel, Kiel, Germany..
Heidelberg Univ, Mannheimer Zentrum Translationale Neurowissensch, Abt Neurophysiol, Mannheim, Germany..
Univ Michigan, Chron Pain & Fatigue Res Ctr, Dept Anesthesiol Med & Psychiat, Ann Arbor, MI USA..
Univ Queensland, Ctr Innovat Pain & Hlth Res CIPHeR, Brisbane, Australia.;Univ Queensland, Sch Hlth & Rehabil Sci, Brisbane, Qld 4072, Australia..
Ruhr Univ Bochum, Dept Med Psychol & Med Sociol, Bochum, Germany..
Queens Univ, Ctr Neurosci Studies, Dept Anesthesiol & Perioperat Med, Biomed & Mol Sci, Kingston, ON, Canada.;Queens Univ, Sch Policy Studies, Kingston, ON, Canada..
Univ Calif Irvine, Susan Samueli Integrat Hlth Inst, Sch Med, Irvine, CA USA.;Univ Calif Irvine, Sch Med, Dept Anesthesiol & Perioperat Care, Irvine, CA USA..
Singapore Inst Technol, Hlth & Social Sci, Singapore, Singapore..
Univ Thessaly, Sch Hlth Sci, Physiotherapy Dept, Clin Exercise Physiol & Rehabil Res Lab, Lamia, Greece..
Univ Cape Town, Neurosci Inst, Dept Anaesthesia & Perioperat Med, African Pain Res Initiat, Cape Town, South Africa..
Vrije Univ Brussel, Pain Mot Res Grp, Brussels, Belgium.;PijnPraxis Be Private Practice Pain Management, Leopoldsburg, Belgium.;Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, Dept Hlth & Rehabil, Gothenburg, Sweden..
Vrije Univ Brussel, Pain Mot Res Grp, Brussels, Belgium.;Inst Fed Rio De Janeiro IFRJ, Phys Therapy Dept, Rio De Janeiro, Brazil.;McGill Univ, Fac Med, Sch Phys & Occupat Therapy, Montreal, PQ, Canada..
Imperial Coll, Chelsea & Westminster Hosp Campus, Dept Surg & Canc, Pain Res Grp, London, England..
Johns Hopkins Univ, Neurosurg Pain Res Inst, Sch Med, Dept Neurosurg, Baltimore, MD USA..
Univ Oxford, John Radcliffe Hosp, Nuffield Dept Clin Neurosci, Oxford, England..
Mayo Clin, Div Rheumatol, Jacksonville, FL USA..
Chron Pain Res Alliance, Milwaukee, WI USA..
Univ Queensland, Ctr Innovat Pain & Hlth Res CIPHeR, Brisbane, Australia.;Univ Queensland, Sch Hlth & Rehabil Sci, Brisbane, Qld 4072, Australia..
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2026 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 167, no 7, p. 1669-1682Article in journal (Refereed) Published
Abstract [en]
Pain treatments have modest effects. Health outcomes might be improved if treatments are matched to mechanisms underlying the persistence and biopsychosocial impact of an individual's pain. The International Association for the Study of Pain (IASP) defines 3 mechanistic pain descriptors presumed to involve different mechanisms - nociceptive, neuropathic, and nociplastic. Although treatments to address each descriptor have been proposed, there is no consensus on how to assign descriptors to clinical presentations. A recent consensus identified candidate clinical features to discriminate between descriptors in clinical practice and research. These need refinement to progress towards a tool. This study aimed to determine the rank and relative weight of identified clinical features to aid discrimination between mechanistic pain descriptors. Candidate clinical features (n = 196) were refined by the IASP Terminology Task Force to converge similar and remove redundant features. The Task Force (n = 24) and an expert panel (n = 39) ranked features using 1000minds conjoint analysis software and assigned weights based on discrete pairwise choices. Participants nominated from pairs of scenarios, which most likely indicated that pain aligned predominantly to a descriptor. Highest ranked features for neuropathic and nociplastic pain were aligned with IASP Clinical Criteria. Criteria for nociceptive pain have not been established. A ranked list of features shared by 2 mechanisms (indicating mixed mechanisms) was also identified. This study identified expert consensus on the highest ranked clinical features with potential to discriminate between pain descriptors, reflective of different underlying mechanisms. This study extends current frameworks by identifying and refining key discriminators for future operationalisation and validation.
Place, publisher, year, edition, pages
Wolters Kluwer, 2026. Vol. 167, no 7, p. 1669-1682
Keywords [en]
Pain, Mechanism-based classification, Nociceptive, Neuropathic, Nociplastic, Consensus, IASP
National Category
Neurology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:uu:diva-593088DOI: 10.1097/j.pain.0000000000003979ISI: 001796693200026PubMedID: 42048572Scopus ID: 2-s2.0-105040031391OAI: oai:DiVA.org:uu-593088DiVA, id: diva2:2082152
2026-06-302026-06-302026-06-30Bibliographically approved