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Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations - 08/08/11

Doi : 10.1016/j.jpain.2007.09.005 
Robert H. Dworkin , Dennis C. Turk , Kathleen W. Wyrwich , Dorcas Beaton §, Charles S. Cleeland , John T. Farrar , Jennifer A. Haythornthwaite #, Mark P. Jensen , Robert D. Kerns , Deborah N. Ader ††, Nancy Brandenburg ‡‡, Laurie B. Burke §§, David Cella , Julie Chandler ¶¶, Penny Cowan ##, Rozalina Dimitrova , Raymond Dionne †††, Sharon Hertz §§, Alejandro R. Jadad ‡‡‡, Nathaniel P. Katz §§§, Henrik Kehlet , Lynn D. Kramer ¶¶¶, Donald C. Manning ###, Cynthia McCormick , Michael P. McDermott ††††, Henry J. McQuay ‡‡‡‡, Sanjay Patel §§§§, Linda Porter , Steve Quessy ¶¶¶¶, Bob A. Rappaport §§, Christine Rauschkolb ####, Dennis A. Revicki , Margaret Rothman ####, Kenneth E. Schmader †††††, Brett R. Stacey ‡‡‡‡‡, Joseph W. Stauffer §§§§§, Thorsten von Stein , Richard E. White ¶¶¶¶¶, James Witter §§, Stojan Zavisic #####
 Departments of Anesthesiology and Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York. 
 University of Washington, Seattle, Washington. 
 Saint Louis University, St. Louis, Missouri. 
§ Institute for Work and Health, University of Toronto, Toronto, Canada. 
 M.D. Anderson Cancer Center, Houston, Texas. 
 University of Pennsylvania, Philadelphia, Pennsylvania. 
# Johns Hopkins University, Baltimore, Maryland. 
 VA Connecticut Healthcare System and Yale University, West Haven, Connecticut. 
†† National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland. 
‡‡ Pfizer, Inc., New York, New York. 
§§ United States Food and Drug Administration, Rockville, Maryland. 
 Evanston Northwestern Healthcare and Northwestern University, Evanston, Illinois. 
¶¶ Merck & Company, Blue Bell, Pennsylvania. 
## American Chronic Pain Association, Rocklin, California. 
 Allergan, Inc., Irvine, California. 
††† National Institute of Nursing Research, Bethesda, Maryland. 
‡‡‡ University Health Network and University of Toronto, Toronto, Canada. 
§§§ Analgesic Research, Needham, Massachusetts. 
 Rigshospitalet, Copenhagen University, Copenhagen, Denmark. 
¶¶¶ Purdue Pharma, Stamford, Connecticut. 
### Celgene Corporation, Warren, New Jersey. 
 McCormick Consultation, Bethesda, Maryland. 
†††† University of Rochester, Rochester, New York. 
‡‡‡‡ University of Oxford, Oxford, United Kingdom. 
§§§§ Elan Pharmaceuticals, Inc., San Diego, California. 
 National Institute of Neurological Disorders and Stroke, Bethesda, Maryland. 
¶¶¶¶ GlaxoSmithKline, Research Triangle Park, North Carolina. 
#### Johnson & Johnson, Raritan, New Jersey. 
 Health Care Analytics Group, United Biosource Corporation, Bethesda, Maryland. 
††††† Duke University Medical Center and GRECC, VA Medical Center, Durham, North Carolina. 
‡‡‡‡‡ Oregon Health and Science University, Portland, Oregon. 
§§§§§ Alpharma, Elizabeth, New Jersey. 
 Tercica, Brisbane, California. 
¶¶¶¶¶ Endo Pharmaceuticals Inc., Chadds Ford, Pennsylvania. 
##### AstraZeneca, Södertälje, Sweden. 

Address reprint requests to Robert H. Dworkin, PhD, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY, 14642.

Abstract

A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments. A group of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT for 4 core chronic pain outcome domains: (1) Pain intensity, assessed by a 0 to 10 numerical rating scale; (2) physical functioning, assessed by the Multidimensional Pain Inventory and Brief Pain Inventory interference scales; (3) emotional functioning, assessed by the Beck Depression Inventory and Profile of Mood States; and (4) participant ratings of overall improvement, assessed by the Patient Global Impression of Change scale. It is recommended that 2 or more different methods be used to evaluate the clinical importance of improvement or worsening for chronic pain clinical trial outcome measures. Provisional benchmarks for identifying clinically important changes in specific outcome measures that can be used for outcome studies of treatments for chronic pain are proposed.

Perspective

Systematically collecting and reporting the recommended information needed to evaluate the clinical importance of treatment outcomes of chronic pain clinical trials will allow additional validation of proposed benchmarks and provide more meaningful comparisons of chronic pain treatments.

Il testo completo di questo articolo è disponibile in PDF.

Key words : Chronic pain, randomized clinical trials, outcome measures, clinical importance, assessment, quality of life, physical functioning, emotional functioning, global ratings


Mappa


 Supported by unrestricted grants to the University of Rochester Office of Professional Education from Allergan, Alpharma, AstraZeneca, Celgene, Elan, Endo, GlaxoSmithKline, Johnson & Johnson, Merck, NeurogesX, Pfizer, Purdue, and Schwarz Biosciences.
 The views expressed in this article are those of the authors. No official endorsement by the US Department of Veterans Affairs, US Food and Drug Administration, US National Institutes of Health, or the pharmaceutical companies that provided unrestricted grants to the University of Rochester Office of Professional Education should be inferred.


© 2008  American Pain Society. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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