Search research articles

ABOUT JoVE

Overview Leadership Blog JoVE Help Center

AUTHORS

Publishing Process Editorial Board Scope & Policies Peer Review FAQ Submit

LIBRARIANS

Testimonials Subscriptions Access Resources Library Advisory Board FAQ

RESEARCH

JoVE Journal Methods Collections JoVE Encyclopedia of Experiments Archive

EDUCATION

JoVE Core JoVE Business JoVE Science Education JoVE Lab Manual Faculty Resource Center Faculty Site

Terms & Conditions of Use

Related Concept Videos

Analgesia and Pain Management

Analgesia and Pain Management

Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by

Same author

Data sharing in stepped-wedge cluster randomized trials: suboptimal data availability despite "data available upon request".

Journal of clinical epidemiology·2026

Same author

Randomized Interventional Effects in Semicompeting Risks, With Application to a Hematopoietic Cell Transplantation Study.

Statistics in medicine·2026

Same author

Spinal Manipulation and Clinician-Supported Self-Management for Preventing Chronic Low Back Pain Impact: The PACBACK Randomized Clinical Trial.

JAMA internal medicine·2026

Same author

CRT-Estimands Framework: consensus based extension of the ICH E9(R1) addendum for cluster randomised trials.

BMJ (Clinical research ed.)·2026

Same author

A tutorial on conducting sample size and power calculations for detecting treatment effect heterogeneity in cluster randomized trials with linear mixed models.

International journal of epidemiology·2026

Same author

Mechanistically informed circulating biomarkers are associated with acquired epilepsy after neonatal brain injury.

Journal of neuroinflammation·2026

Search research articles

Related Experiment Video

Updated: Mar 14, 2026

Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery

Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery

Published on: April 14, 2016

Estimating controlled direct treatment effects on pain intensity using structural mean models.

Rui Wang¹, Patrick J Heagerty^1,2, Kwun Chuen Gary Chan¹

¹Department of Biostatistics, University of Washington, Seattle, WA, USA.

|March 13, 2026

Summary

New causal inference methods accurately estimate pain treatment effects by accounting for analgesic use. These advanced techniques in randomized controlled trials (RCTs) provide more reliable results for pain management.

Keywords:

Causal inference Concurrent analgesic use Intercurrent treatment Mediation analysis Pain clinical trials Structural mean models

More Related Videos

Author Spotlight: Quantifying Pain Experience – An Illustrative Approach Using the Pain Body Diagram

Author Spotlight: Quantifying Pain Experience – An Illustrative Approach Using the Pain Body Diagram

Published on: July 7, 2023

Psychophysically-anchored, Robust Thresholding in Studying Pain-related Lateralization of Oscillatory Prestimulus Activity

Psychophysically-anchored, Robust Thresholding in Studying Pain-related Lateralization of Oscillatory Prestimulus Activity

Published on: January 21, 2017

Related Experiment Videos

Last Updated: Mar 14, 2026

Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery

Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery

Published on: April 14, 2016

Author Spotlight: Quantifying Pain Experience – An Illustrative Approach Using the Pain Body Diagram

Author Spotlight: Quantifying Pain Experience – An Illustrative Approach Using the Pain Body Diagram

Published on: July 7, 2023

Psychophysically-anchored, Robust Thresholding in Studying Pain-related Lateralization of Oscillatory Prestimulus Activity

Psychophysically-anchored, Robust Thresholding in Studying Pain-related Lateralization of Oscillatory Prestimulus Activity

Published on: January 21, 2017

Area of Science:

Pain research
Clinical trials methodology
Causal inference

Background:

Concurrent analgesic use can diminish primary analyses of pain intensity in pain randomized controlled trials (RCTs).
Traditional methods like strict intention-to-treat (ITT) analysis may not adequately account for analgesic use.
Accurate estimation of treatment effects is crucial for effective pain management.

Purpose of the Study:

To reanalyze RCT data using contemporary causal inference methods to account for concurrent analgesic use.
To define and estimate an "attributable to ESI estimand" representing the controlled direct effect of epidural steroid injection (ESI).
To compare treatment effects estimated by structural mean models (SMMs) with traditional methods.

Main Methods:

Employed structural mean models (SMMs) and a composite pain intensity outcome (QPAC1.5) to estimate the "attributable to ESI estimand."
Utilized three SMM estimation methods: estimating equations, g-estimation, and generalized method of moments.
Compared SMM results with strict intention-to-treat (ITT) analysis for leg pain intensity using the numeric rating scale.

Main Results:

The treatment effect of ESI on leg pain intensity using strict ITT was -0.751 (95% CI: -1.287 to -0.214).
Estimates for the "attributable to ESI estimand" varied across SMM methods, ranging from -0.653 to -0.935.
The QPAC1.5 composite outcome yielded an effect estimate of -0.930 (95% CI: -1.508 to -0.352).

Conclusions:

Contemporary causal inference methods and alternative estimands can effectively account for concurrent analgesic use in pain RCTs.
These methods may lead to larger and potentially more accurate estimations of treatment effects for pain interventions.
The study highlights the importance of addressing analgesic use for robust pain management research.