Emma Fisher

Pain states fluctuate over time and across situations. Similarly, there is variation in risk and protective factors and how they impact on these pain-related transitions. We are interested in whether such variations are more than random, and whether they can be accounted for by observed variables. The availability of large longitudinal datasets, such as UK Biobank (https://www.ukbiobank.ac.uk/), offers a unique opportunity to study these variations at scale. However, such datasets bring a high risk of bias (eg, confounding) and danger of over-interpretation. It is therefore important to be transparent about our causal thinking. Directed acyclic graphs (DAGs) are graphical representations of the hypothesized causal relationships between variables. They are used to identify the smallest set of variables that need to be adjusted to remove confounding bias in estimating the causal effect of an exposure on an outcome. However, use of DAGs in pain research is not common, despite their potential to guide study design and data analysis. In this article, we present a workflow for building a DAG using domain knowledge from 3 different sources: researchers (theory-based), people with lived experience (person-based), and the literature (evidence-based). We created a DAG for the putative effect of executive function on the maintenance of chronic high-impact pain. The resulting DAG provides a valuable framework for guiding future research on the role of executive functioning in pain, and it underscores the broader potential of using DAGs to improve causal inference in pain research.

Retractions are common in pain and anaesthesiology research but often fail to reduce citation of untrustworthy studies. The International Committee of Medical Journal Editors instructs authors to ensure that references of the articles they submit for publication do not cite retracted articles, however, few journals include this guidance in their article submission instructions. This pre-post study evaluated the effect of an audit and feedback intervention on the inclusion of retraction-checking guidance in the top 20 pain and top 20 anaesthesiology journals. At baseline audit, 3 journals included guidance on checking references for retracted studies. Twelve months after tailored feedback to editors-in-chief, 10 recommended checking for retractions and 8 provided guidance on how to identify them - an overall improvement of 17.5%. Changes in 3 journals were directly linked to the intervention. These findings suggest audit and feedback may help reduce citation of retracted literature.

Background: Complex regional pain syndrome (CRPS) is a chronic pain condition which typically affects a body extremity and occurs more frequently from the onset of adolescence. Parents of adolescents with chronic pain report uncertainty and fear concerning their adolescent's transition to adulthood. Nonetheless, little is known about how parents of adolescents with CRPS perceive their adolescent's future. Methods: This study sought to explore the future perceptions of parents of adolescents with CRPS ( n = 45) and compare their use of language with a sample of parents of adolescents without chronic pain ( n = 50). All participants completed an online story completion task in which they described their imagined future for their adolescent (14–25 years). Responses were coded using a linguistic analysis programme and the significance of group differences was tested using inferential statistics. Results: Parents of adolescents with CRPS used significantly more negative emotion and anger words, and their responses had an overall lower emotional tone score (i.e., were more negative) than parents of pain‐free adolescents. Parents of pain‐free adolescents used significantly more certainty and friends words. Adolescent age and gender predicted a significant amount of variance in use of family words. No group differences were found for the remaining dimensions. Conclusions: Key differences exist regarding expectations of their adolescent's future between parents of adolescents with and without chronic pain. Given the important contribution of parents to the pain experience of their adolescent, and the influence of parental expectations on future outcomes, interventions should target the future‐focused expectations of parents. Significance Statement: Parental expectations of their adolescent's future may be impacted by the presence of their adolescent's chronic pain condition. Our findings point to the importance of considering and targeting parental future perceptions in paediatric chronic pain interventions.