Although certain risk factors can identify individuals who are most likely to develop
chronic pain, few interventions to prevent
chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of
chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing
chronic pain. Specific design considerations included subject identification, timing and
duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of
chronic pain prevention (ie,
chronic postsurgical pain,
postherpetic neuralgia, chronic
low back pain, and painful
chemotherapy-induced
peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other
chronic pain conditions. These examples were selected because they are representative models of primary and
secondary prevention, reflect persistent
pain resulting from multiple insults (ie, surgery,
viral infection, injury, and toxic or noxious
element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of
chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of
chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.