Optimizing and Accelerating the Development of Precision Pain Treatments for Chronic Pain: IMMPACT Review and Recommendations

Robert R. Edwards, Kristin L. Schreiber, Robert H. Dworkin, Dennis C. Turk, Ralf Baron, Roy Freeman, Troels S. Jensen, Alban Latremoliere, John D. Markman, Andrew S.C. Rice, Michael Rowbotham, Roland Staud, Simon Tate, Clifford J. Woolf, Nick A. Andrews, Daniel B. Carr, Luana Colloca, Doina Cosma-Roman, Penney Cowan, Luda DiatchenkoJohn Farrar, Jennifer S. Gewandter, Ian Gilron, Robert D. Kerns, Serge Marchand, Gwendolyn Niebler, Kushang V. Patel, Lee S. Simon, Tina Tockarshewsky, Geertrui F. Vanhove, Daniel Vardeh, Gary A. Walco, Ajay D. Wasan, Ursula Wesselmann

Research output: Contribution to journalReview articlepeer-review


Large variability in the individual response to even the most-efficacious pain treatments is observed clinically, which has led to calls for a more personalized, tailored approach to treating patients with pain (ie, “precision pain medicine”). Precision pain medicine, currently an aspirational goal, would consist of empirically based algorithms that determine the optimal treatments, or treatment combinations, for specific patients (ie, targeting the right treatment, in the right dose, to the right patient, at the right time). Answering this question of “what works for whom” will certainly improve the clinical care of patients with pain. It may also support the success of novel drug development in pain, making it easier to identify novel treatments that work for certain patients and more accurately identify the magnitude of the treatment effect for those subgroups. Significant preliminary work has been done in this area, and analgesic trials are beginning to utilize precision pain medicine approaches such as stratified allocation on the basis of prespecified patient phenotypes using assessment methodologies such as quantitative sensory testing. Current major challenges within the field include: 1) identifying optimal measurement approaches to assessing patient characteristics that are most robustly and consistently predictive of inter-patient variation in specific analgesic treatment outcomes, 2) designing clinical trials that can identify treatment-by-phenotype interactions, and 3) selecting the most promising therapeutics to be tested in this way. This review surveys the current state of precision pain medicine, with a focus on drug treatments (which have been most-studied in a precision pain medicine context). It further presents a set of evidence-based recommendations for accelerating the application of precision pain methods in chronic pain research. Perspective: Given the considerable variability in treatment outcomes for chronic pain, progress in precision pain treatment is critical for the field. An array of phenotypes and mechanisms contribute to chronic pain; this review summarizes current knowledge regarding which treatments are most effective for patients with specific biopsychosocial characteristics.

Original languageEnglish (US)
Pages (from-to)204-225
Number of pages22
JournalJournal of Pain
Issue number2
StatePublished - Feb 2023


  • Pain
  • biomarker
  • neuropathic
  • personalized
  • phenotype
  • precision
  • quantitative sensory testing

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Anesthesiology and Pain Medicine


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