Earlier this month, the IASP (International Association for the Study of Pain) meeting marked a significant moment in honoring the vision of Professor John Bonica founder of IASP. In 1973, Professor Bonica successfully convened a group of experts in Issaquah, Washington, to chart a path forward for improving the lives of patients suffering from pain. His vision emphasized that effective pain management required a comprehensive approach—one that not only investigates the underlying mechanisms of pain but also integrates the experiences of inter-disciplinary pain therapists1. Over the past 50 years, this holistic effort has led to tremendous advances in our understanding of pain through translational science, ultimately improving treatment options. However, it is clear that more work remains2. The complexity and diversity of pain etiologies demand continued efforts to reduce the burden on patients. The unmet needs are significant, and as we develop new and more effective treatments, the voices of patients must be heard.
As we reflect on these advances, it’s crucial to recognize a critical aspect that has often been neglected: the need to view patients not just through the lens of their disease or pain, but as whole individuals whose interactions with healthcare, their social environment, and the broader societal context also play pivotal roles in their experience of pain. These interactions are complex and difficult to capture in a formalized way, yet they are essential to understanding and effectively treating pain. To illustrate this, I want to share a specific yet crucial aspect that was central to a workshop and side conversations during the conference and that deserves more attention—the influence of diversity on pain management. This is just one example among many that require further study and consideration, but it is a particularly pressing issue that reflects the broader challenges in patient-centered care.
As an example, a panel of three speakers—Dr. Anna Hook from the University of Manchester, Dr. Staja Booker from the University of Florida, and Dr. Vani Mathur from Texas A&M University—captured my attention with their session titled “Understanding Disparities and Inequities: A Critical Approach to Pain.” They presented compelling evidence showing how various factors are interconnected. For example, the emotional damage caused by repeated experiences of inequities can significantly influence pain perception, as can disparities and injustices in healthcare. The speakers emphasized that the injustice of pain is closely tied to social injustice, and the context in which individuals live can profoundly affect their experience of pain. Ignoring these factors in pain management risks failing to address pain effectively. These insights underscore the importance of considering patients’ social environments and lived experiences in developing comprehensive pain management strategies.
To further support these points, I selected several references from posters presented during the congress3-7. When we shift our focus to developing effective pain treatments or drugs, it becomes evident that clinical trials often fail to adequately consider these critical aspects. Without addressing factors like societal inequity and lived experiences in trial designs, we risk overlooking key variables that could impact the effectiveness and accessibility of new treatments.
Although these characteristics may introduce variability in drug testing, they are crucial to ensuring that new treatments are effective. Addressing these factors is not only a matter of scientific rigor but also of ethical/societal responsibility. Regulatory authorities are increasingly recognizing the importance of diversity in clinical trials, as reflected in their ongoing efforts to provide guidance on this issue (draft guidance: Diversity Action Plans to Improve Enrollment of Participants from Underrepresented Populations in Clinical Studies Guidance for Industry). By incorporating these considerations into drug development, we can ensure that new treatments benefit all patients, regardless of their background or circumstances, ultimately leading to more just and effective healthcare outcomes.
References:
- Sessle BJ. Introduction and a brief historical overview of the International Association for the Study of Pain. Pain. 2023 Nov 1;164(11S):S3-S5. doi: 10.1097/j.pain.0000000000003057. PMID: 37831952.
- Basbaum AI, Jensen TS, Keefe FJ. Fifty years of pain research and clinical advances: highlights and key trends. Pain. 2023 Nov 1;164(11S):S11-S15. doi: 10.1097/j.pain.0000000000003058. PMID: 37831954; PMCID: PMC10787538.
- Presenting Author: Zina Trost: Unveiling the Digital Divide: Sociodemographic Analysis of US Virtual Reality Interventions for Pain
- Presenting Author: Sarah Nelson Amplifying patient voices around diversity, equity, and inclusion in pediatric pain treatment
- Presenting Author: Karime Mescouto Applying an intersectional lens to explore pain management encounters: a qualitative study
- Presenting Author: Fiona Webster The structural violence of disability benefits in contexts of chronic pain
- Presenting Author: Troy C. Dildine: Relation of Opioid Use and Pain Interference to Experiences of Discrimination, Stress, and Vigilance
