Journal article
Towards a tool to discriminate between pain mechanistic descriptors: expert ranking of clinical features and allocation of weights using a forced choice paradigm
- Abstract:
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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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
-
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(Preview, Version of record, pdf, 1.2MB, Terms of use)
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- Publisher copy:
- 10.1097/j.pain.0000000000003979
Authors
- Funder identifier:
- https://ror.org/029chgv08
- Grant:
- 222101/Z/20/Z
- Funder identifier:
- https://ror.org/011kf5r70
- Grant:
- 1091302
- Funder identifier:
- https://ror.org/00k86s890
- Grant:
- R01 AR073187
- Funder identifier:
- https://ror.org/036s6ct29
- Publisher:
- Lippincott, Williams & Wilkins
- Journal:
- Pain More from this journal
- Publication date:
- 2026-04-29
- Acceptance date:
- 2026-02-22
- DOI:
- EISSN:
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1872-6623
- ISSN:
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0304-3959
- Pmid:
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42048572
- Language:
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English
- Keywords:
- Pubs id:
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2413931
- Local pid:
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pubs:2413931
- Deposit date:
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2026-05-12
- ARK identifier:
Terms of use
- Copyright holder:
- Shraim et al.
- Copyright date:
- 2026
- Rights statement:
- Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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