Saurab Sharma

Trustworthy pain research is essential for developing a deeper understanding of the phenomena, how it is experienced, its many impacts and how it might be reduced, prevented or managed to improve the lives of those who live with pain. Recognising multiple critical challenges that undermine trust in health research, an international, interdisciplinary network was convened to create an integrated framework for enhancing the trustworthiness of research in pain. The ENTRUST-PE framework was launched in 2024 with a call to action, proposing that trustworthiness in pain research is multidimensional and underpinned by 7 Core Values: Integrity and Governance; Equity, Diversity and Inclusivity; Patient and Public Involvement and Engagement; Methodological Rigour; Openness and Transparency; Balanced Communication and Data Authenticity. The framework includes specific recommendations for a range of interest holders and resources to support those recommendations. In this paper, we summarise the framework, reflect on the response to the framework from the pain research community, consider challenges and opportunities in the evolving research landscape and suggest how we might move towards deeper implementation to enhance the trustworthiness of pain research.

Equitable, high-value pain care remains out of reach for many populations worldwide, particularly for people living in low- and middle-income countries and cultural minority groups in high-income settings. Despite carrying a disproportionate burden of chronic pain, these populations remain underrepresented in high-quality pain research, underserved by existing health systems, and constrained by social, political, environmental, and commercial determinants of health. The lack of locally generated evidence forces clinicians and policymakers to rely on externally produced research that may not translate to local cultural, linguistic, or health-system contexts. This invited viewpoint synthesizes key contributors to pain inequity—including limited prioritization of chronic pain in low- and middle-income countries, underdeveloped rehabilitation capacity, poor access to essential treatments, commercial exploitation, and misalignment between culturally shaped pain beliefs and Western-derived assessment and treatment models. I highlight opportunities to strengthen equity in clinical care through improved education of health professionals and the public, culturally and linguistically responsive assessment, and contextually adapted self-management and treatment strategies. Equitable research requires standardized collection of sociodemographic variables, deliberate inclusion of underrepresented groups, and global partnerships that avoid colonizing practices. I propose principles for fair and impactful North–South collaborations focused on co-creation of research agendas, shared leadership, sustainable capacity building, and transparent governance. Advancing equitable global pain care and research will require collective action from clinicians, researchers, institutions, policymakers, journals, funders, and communities. A coordinated shift toward culturally grounded, contextually adaptable, and ethically collaborative approaches is essential to meaningfully reduce global pain disparities and ensure all individuals benefit from scientific progress.

Culturally and linguistically diverse (CALD) populations experience disproportionate burdens of chronic disease compared to the general population; previous research demonstrated group-based interventions improve health outcomes across various chronic conditions. This umbrella review aims to summarise the available evidence concerning group-based interventions for CALD populations with chronic conditions. We conducted this umbrella review in accordance with the Cochrane Handbook for Systematic Reviews of Interventions , reported per PRISMA, and quality-assessed using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, version 2). We searched 11 databases (MEDLINE, Embase, Emcare, CINAHL, PsycINFO, SCOPUS, Web of Science, Cochrane, Epistemonikos, LILACS, and SciELO citation index of Web of Science) from inception to June 3, 2025, without language restrictions. All screening, data extraction, and quality assessment were carried out in duplicate. We descriptively synthesised the findings and determined the effectiveness and effect sizes of interventions as concluded by the review authors. We identified 22 systematic reviews, 271 primary studies, and over 32,320 people. Reviews originated from high-income countries; published in the last 10 years (82%); most (13) scored low on AMSTAR-2 quality rating. Reviews were related to mental health conditions (15), diabetes (4), chronic pain (1), cancer (1), and mixed chronic health conditions (1). Group-based Psychological Interventions reported positive effects on depression, anxiety, and PTSD symptoms, well-being, and quality of life. Educational Interventions improved diabetes outcomes (notably glycated haemoglobin), psychosocial outcomes in mental health, and pain, fatigue, physical activity, and self-efficacy in other chronic conditions. Multimodal Interventions improved psychosocial outcomes for mental health, pain, and disability outcomes for chronic pain. Some reviews reported mixed findings or insignificant effects. Overall, group-based interventions improved health, mental well-being, and biopsychosocial outcomes in CALD populations with chronic conditions. However, evidence remains limited; study heterogeneity (interventions, populations, outcomes) was marked. Future research should prioritise clearly describing the development, design, and implementation of interventions to meet the complex and diverse needs of CALD populations.

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.