Emerging clinical pain research in low- and middle-income settings: towards a person-centred approach

Group-based randomized controlled trials (RCTs) in clinical pain research in low- and middle-income settings (LMIS) face distinct challenges, including resource-related limitations and contextual barriers. In addition, evidence garnered through RCTs in high-income settings is often not directly relevant to LMIS. We briefly discuss alternative group-based study designs that can address some of these challenges. We then introduce single-case experimental designs as a complementary approach that may be more efficient than traditional group-based methods in these contexts. Single-case experimental designs focus on the individual person in relation to at least one independent variable over time under different conditions. Unlike RCTs, they require small sample sizes and provide more granular insights into how a pain intervention affects each individual rather than the average group response. Single-case experimental designs can also accommodate more diverse participants in terms of age, ethnic backgrounds, and comorbidities, making them resource-efficient, clinically relevant, and pragmatic, which can facilitate more clinical trials in LMIS, and thereby a better understanding and scientific evidence for the effects of treatments in these settings.