FDA-Regulated Clinical Trials vs. Real-World Data: How to Bridge the Gap in Pain Research

Randomized controlled trials (RCTs) have been regarded as the gold standard for evaluating the efficacy of treatments for chronic pain and are the foundation for regulatory approval and guideline development. However, their restrictive design and dependence on idealized populations can limit their applicability to the diverse patients seen in routine chronic pain management. Real-world data (RWD), collected from electronic medical records, registries, claims databases, and digital health platforms, can offer a more comprehensive view of treatment adherence and safety that RCTs often overlook. A key issue in pain medicine is the efficacy-effectiveness gap, where discrepancies exist between the outcomes of therapies and interventions in RCTs versus in real-world practice due to variations in patient populations and adherence. Bridging this gap ensures that observed improvements align with patients' preferred outcomes and functional goals. Integrating the strengths of RCTs and RWD provides a more comprehensive evidence base to guide clinical decision-making, influence reimbursement policies, and develop equitable guidelines. The primary aim of this paper is to identify factors used in FDA-regulated RCTs and RWD that could be implemented or enhanced in everyday practice to deliver more holistic and patient-centered care in the management of chronic pain.