Identifying person-centred pain profiles using a multidimensional evaluation framework
Pain is a complex and personal experience that is the result of an interaction between biological signals, psychological status, and social context. Classifying pain is equally challenging, and placing people into distinct categories can be imperfect and misrepresent what pain is and how to manage it. This line of research aims to better understand the experience of pain through multi-domain evaluation and interpretation of patient experiences.
Project status – Data Collection complete, analyses ongoing
Tissue damage can lead to pain, but the relationship is often not obvious. There are several examples of tissue damage without pain, just as there are examples of pain with no obvious tissue damage. This causes problems for traditional methods of pain management, because too often the root(s) of the problem are hard to define. There have been several methods to classify pain in the past, but all have been imperfect and highlight the challenge of placing people with complex, unique, and personal experiences into distinct and well-defined boxes. We propose that pain is best understood not through the identification of a single primary mechanism, but through the interplay of several mechanisms occurring concurrently. We therefore believe that a multidimensional approach to pain assessment and profiling, sometimes called ‘phenotyping’, allows for multiple drivers of the pain experience to exist in the same person and to contribute to the experience of their pain to relatively greater or lesser extents. By identifying the drivers with the greatest contribution, we believe more person-centred pain management strategies can be created that are unique to each person’s experience. This line of research represents a long-term process of creating, testing, revising, and finally disseminating different methods for understanding the pain experienced by another person.
CANSpine Researchers
David Walton
Collaborators
James Elliott
Joy MacDermid
Jackie Marsh
Purpose
To create new strategies for evaluating and assessing pain of another person, through strategies such as centring patient narrative, novel multidimensional assessment tools, and new clinical tests that provide rich information about the relative contributions to the pain experience.
Findings
A new framework for clinical pattern recognition in pain assessment has been published and new measurement tools to tap each of 7 primary drivers of pain have been developed or are under development. Using a large dataset from Veterans of Canada’s Armed Forces we have identified what appear to be meaningful profiles through use of the 7-domain framework, and are now working to externally validate those profiles in an independent population of injured workers in Ontario.
Impact
The 7-domain framework has been described in the book “Musculoskeletal Pain: Assessment, Prediction, and Treatment” by Walton and Elliott, published by Handspring Publishers UK. One of the measurement tools arising out of this work, The MultiDimensional Symptom Index, is provided under license from Western University’s WorlDiscoveries commercialization body. Dr. Walton has provided independent consultation to both large and emerging clinical entities wanting to create more holistic, person-centred pain evaluation strategies.
Key Publications
Walton, D. M., & Elliott, J. M. (2018). A new clinical model for facilitating the development of pattern recognition skills in clinical pain assessment. Musculoskeletal science & practice, 36, 17–24.
Walton, D. M., & Marsh, J. (2018). The Multidimensional Symptom Index: A new patient-reported outcome for pain phenotyping, prognosis and treatment decisions. European journal of pain, 22(7), 1351–1361.
Funding
The pain phenotyping project was funded through a grant from the Chronic Pain Centre of Excellence – Veteran’s Health awarded to Drs. MacDermid and Walton. The independent external validation study has been funded by the Ontario Workplace Safety and Insurance Board awarded to Dr. Walton
